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pharmacology final ( 1st sem) > B: 14-16 > Flashcards

B: 14-16 Flashcards

(65 cards)

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1
Q

Pharmacotheraputic aims of Manangement of HF

A

↓ Preload
↓ Afterload
↓ Cardiac muscle remodeling
↑ Contractility (Ionotropic)

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2
Q

What is Preload?

A

Volume of blood in the ventricles at the end of diastole

Stretch

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3
Q

What is Afterload?

A

Resistance left ventricle must ovrcome to pump blood

Squeeze

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4
Q

Which drugs can help lower preload?

A

Diuretics
ACEI
ARB’s
Venodilators

Less blood in the heart system

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5
Q

Which drugs can help lower afterload?

A

ACEI
ARB’s
Arteriodilators

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6
Q

Which drugs can help increase contractility?

A

Digoxin
B agonists
PDE-III inhibitors

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7
Q

Which drugs can help lower cardiac muscle remodeling?

A

ACEI
ARB’s
Spironolactone
B blockers

Help improve survival!

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8
Q

Digoxin is for Acute/chronic management of HF?

A

Chronic

systolic failure!!

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9
Q

Which diuretics are given in case of HF?

A

Thiazides: Hydrochlorothiazides
Loop diuretics: Furosemide
K+ sparing agents: Spironolactone

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10
Q

ACE inhibitors which are given in case of HF?

A

Captopril
Enalapril
Perindopril
ramipril

אפריל מהאופיס קצת דומה לאייס

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11
Q

ARB’s which are given in case of HF?

A

Losartan
Valsartan
Irbesartan

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12
Q

B blockers which are given in case of HF?

A

Metoprolol (B1 selective antag.)

Carvedilol (B and a)

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13
Q

Positive iontropic agents

A

Cardiac glycosides: Digoxin, Digitoxin
Sympathomimetics: Dobutamine
PDE-inhibitor: Milrinone

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14
Q

Cardiac glycosides MOA

A

Inibition of cadiac Na/K ATPase → Na/Ca exchanger wont work as well → I.C Ca2+ conc. ↑ → increased Ca release from SR → Increased actin-myosin interaction → positive ionotropic (contractility)

Inhibition of neuronal Na/K ATPase → vagal activity ↑ → Negative chronotropic (HR)

AV conduction ↓ → Negative dromotropic (AV conduction)

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15
Q

Digoxin drug properties

A 
Oral: bioavailability 75%
Narroe theraputic index
Onset of action 0.5-1 h
Elimination half life 30-40 h: requires loading dose
Renal elimination
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16
Q

Digoxin displacement by which other drugs?

A

Quinidine
Amiodarone
Verapamil

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17
Q

Digoxin indications

A

Chronic HF (positive inotropic) systolic failure

Arrhythmias: SVT, A.Fib, A.Flutter ( decreases AV conduction, increases AV refractory period)

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18
Q

Digoxin adverse effects

A 
Hyperkalemia
GI
ECG changes
Conduction blocks
Arrhythmias
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19
Q

Predisposing factors for Digoxin toxicity

A

Renal impairment
Hypokalemia
Hypomangesemia
Hypercalcemia

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20
Q

Treatment for Digoxin toxicity

A

Correcting electrolyte (Mg , K )

Class Ib: Lidocaine, Phenytoin

digoxin Antibodies (Fab fragment)

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21
Q

Digoxin contraindications

A

Hypertrophic cardiomyopathy
AV block
Diastolic HF

WPW syndrome

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22
Q

Digitoxin drug properties

A

Oral: bioavailability 90%
Onset of action 3-6 h
Elimination half life 5-7 h: requires loading dose
Hepatic metabolism

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23
Q

Digitoxin indications

A

CHF

Arrhythmias: SVT, A.Fib, A.Flutter

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24
Q

Dobutamin

Tell me about it

A

B1 selective agonist
Parenteral
Duration is minutes

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25
Dobutamine indications and CI
Acute HF: Systolic function ↑ CI : in chronic treatment due to tolerance, low oral bioava, arrythmogenic effect
26
PDE inhibitor for the management of AHF?
Milrinone
27
Milrinone MOA
PDE-inhibitor ↑ cAMP in heart muscle: Positive ionotropic (Contractility) ↑ cAMP in vascular smooth muscle: TPR ↓
28
How to give Milrinone?
IV
29
Milrinone indication and contra
AHF Contra. in chronic treatment due to increased morbidity, mortality)
30
Levosimenadan MOA
Ca2+ sensitizing agent: - Sensitize troponin to Ca --> (Positive ionotropic) - Inhibits PDE (Vasodilation) - Open ATP-sensitive K ch (Vasodilation)
31
Ca2+ sensitizing agent
Levosimenadan
32
Levosimenadan indications
Acute decompensated HF`
33
Levosimenadan contra.
Hypotension
34
What each class I AA do to the Action potential?
Ia (procainamide) : Prolonged AP Ib (lidocaine, phenytoin) : Shorten AP in some cardiac tissue esp. purkinje Ic (flecainide) : No effect on AP
35
Class Ia MOA and names
- Blocks open/inactive FAST Na+ ch "state dependent blockade" - tissues undergoing Frequent depol are more susceptible to inhibition - Blocks K+ ch so prolonged repol. - increased AP duration, Effective refractory period Procainamide Quinidine disopyramide
36
Class Ib MOA and names
- Blocks inactivated Na ch. (minimal effect on normal tissue bcz selectively affect ischemic or depolarized purkinje & ventricle) little effect on atria shorten AP & refractory period Lidocaine mexiletine phenytoin
37
Lidocaine indications
Ventricular arrhythmias Post MI Digoxin toxicity
38
Lidocaine side effects
Seizures | Least cardiotoxic!
39
Class Ic MOA and names
- Block fast Na ch. - His-Purkinje tissue - No ANS effects Propafenone flecainide
40
flecainide, Propafenone is given
Oral
41
Class II AA
Esmolol (Propranolol) metoprolol
42
Esmolol AA indications
Perioperative thyrotoxicosis arrhythmias emergency acute arrythmias
43
Class III AA MOA
K+ ch. blockrs (prolongs AP, RP) Rhythm control amiodarone Dronedarone sotalol (BB + K-blocker)
44
Class III AA drugs
Amiodarone | Sotalol
45
Amiodarone drug properties
Blocks Na, B-adrenoreceptor, K, Ca, ( has group 1, 2, 4 AA actions) greatest AP prolonging effect HR ↓ AV node conduction ↓ Elimination half life 1-10 weeks Binds to tissues Inhibits CYP450 (Careful with Warfarin, Statins) oral, parenteral
46
Amiodarone side effects
Thyroid abnormalities Skin and cornea deposition Pulmonary fibrosis optic neuritis
47
Sotalol MOA
Blocks K+ ch. | Non selective B blocker
48
Sotalol | How to give? Duration?
Oral | 7 h
49
Sotalol indications
Ventricular arrhythmias A.Fib (May cause Dose dependent TdP)
50
Class IV AA MOA
Blocks L type Ca2+ ch. Non-dihydropyridines more selective for myocardium!!
51
Class IV AA drugs | How to give?
Verapamil Oral, parenteral D= 7hrs Diltiazem oral, parenteral D= 6hrs
52
Verapamil indications Diltiazem indic
Verapamil : AV nodal arrhythmias esp in prophylaxis Diltiazem : Rate control in atrial fibrillation
53
Verapamil, diltiazem side effects
- Cardiac depression - Constipation - Hypotension
54
Class V AA drugs
Adenosine Mg2+ Digoxin
55
Adenosine R and their G protein
A1-R-(Gi): K+ current ↑, Ca2+ current ↓, hyperopolariz. -increase in diastolic K current --> hyperpolar --> conduction block A2-R-(Gs) : Vasodilation
56
Adenosine | How to give? Duration?
IV | 10-15 seconds!
57
Adenosine indications
-Acute nodal tachycardia (book) AV arrhythmias Paroxysmal SVT
58
Adenosine side effects
- bronchospasm - chest pain - Flushing - headache
59
Adenosine can be antagonized with
Theophylline
60
Mg++ as an AA
- possibly increase in Na/K ATPase
61
Mg++ is given how
IV
62
Mg++ indications
TdP Long QT syndrome Digitalis induced arrhythmias arrythmias if serum K is low
63
Digoxin as an AA
Inhibition of neuronal Na/K ATPase → Vagal tone ↑ → negative chronotropic AV conduction ↓ → negative dromotropic inhibits Na/K ATPase --> interfere with Ca/Na exchanger--> increased IC Ca --> increase inotropy (contractility)
64
Rate control. Which AA will we choose? Indications?
Class II (BB) and IV (CCB) Age > 65 Hypertension AF
65
Rhytm control. Which AA will we choose? Indications?
``` Class I and III Age < 65 More symptomatic No hypertension New AF ```

pharmacology final ( 1st sem) (15 decks)

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