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Flashcards in CV Pharmacology 1 Deck (265):
1

Adverse Reactions iwth Fondarinux

Hemorrhage

Hypersensitivity

NO Thrombocytopenia

Osteoporosis if used long term

2

Type of drug - Disopryamide

Class Ia: Na Channel Block

3

Direct Thrombin Inhibitor  - mechanism

Argatroban

Inhibits IIa without Antithombin III combination

4

Diuretic effectivity

Loop+thia>Lopp>thia>AA

5

Hyperkalemia

decreased AP duration and conduction Peaked T waves

6

ADP Receptor Antagonists drugs

Clopidogrel (Plavix)

Ticagrelor

Prasugrel

7

Heparin Overdose

Bleeding from nose, hematuria, bloody stools that leads to bruising.

Treatment is Protamine which neutralizes heparin in 5 minutes via IV at dose of <50 mg/10mines.

Incomplete reversal with LMWH

8

Uses of nitrages

Acute Angina (sublingal or translingual spray for rapid action)

Prophylaxis for stable agina: long acting oral, topical, transdermal. Good if poor tolerance to Beta blockers or in combo with beta blockers

 

Perioperative hypertension

9

what drugs have increased risk of hypokalemia

Loop diuretics, Thiazide, Digoxin

10

How to treat irregular tachyarrhythmias?

Rate control, ani arrhythmics, cardioverson

11

Dobutamine

beta agonist to use pt is hypotensive

12

How do Class 3 drugs prolong refractory period?

increased phase 2 which leads to increase Na inactivation.

13

Class 2 drugs

antagonist to Beta-AR to block sympathetic effect of NE to slow pacing HR and increase refractory period. Also inhibit cardiac remodeling.

14

milrinone

Phosphodiesterase inhibitor to block cAMP degradation. use if on beta blocker.

15

Effect of heart rate - CCB

Diltiazem > Verapamil at lowering

Nifedipine increases

16

SE of adenosine

flushing, headache, AV block

17

SE of Milrinone

hypotension, thrombocytopenia, arrhythmia, fever

18

Type of drug - Furosimide

Loop Diuretic - blocks Na/K/Cl in transverse ascending loop

19

Type of drug - Captorpril

ACE I

20

Suppression of contractility - CCBs

Verapamil > Diltiazem > Nifedipine

21

causes of atrial fibrillationg

hypertension, Mitral valve disease, Alcohol, cardiomyopathy, hyperthyroidism

22

contraindications for Class 2

Asthma, CPOD

23

Type of drug - Butetanide

Loop Diuretic - blocks Na/K/Cl in transverse ascending loo

24

ENDING FOR BETA BLOCKERS

LOL

25

Vasodilators on HR

B blocks and diltizem decrease most, then verapamil

Nitrates and nifedipine increase

26

Antiplatelet drugs

Aspirin

Alopidogrel (ADP receptor antagonists)

Dipyridamole (blocks Phosphodiesterase)

Abcixibman (G IIb/IIA receptor blocker)

27

Type of drug - Diltiazen

Class IV, Ca Channel Blocker

28

Ranolazine - types and mechansim

Vasodilator

no effect on HR or BP

inhibits late Na current (prevent Na inactivation to prevent Na intracellular overloa dnad NCX reversal to increase Calcium to increas mechanism dysfunction and O2 demand.

29

dosing for ACE I

Lisinopril QD> Enalatrpil BID > Captopril TID

30

Nifedipine vs Verapamil vs. Diltiazen

Nifedpine is a dihydropyridine calcium channel blocker that works more on vascular SMC than carcia

The other two work on cardiac

31

Adenosine to Atrial Tachycardia

CHB, then could terminated.

32

Type of drug - Metoprolol

Beta- Blocker Class 2

33

uses of ACEI

hypertention, HF (HFrEF) and MI

34

Fondarinux - class and mechanism

Anticoagulant

Pentasaccharide activator of Antithrombin III to inactivate Xa

35

Class 1- Refractory period (A vs. B. vs C)

slower repolarization: 1A>1C> 1B (faster!)

36

Type of drug - Nifedipine

Class IV, Calcium Channel blocker

37

Inotropes Inotropy potential

NE>Dopamien>dobutamine>milrinone

38

uses of Class II

V tach, SVT, A fib/flutter

39

Warfin - mechanism

acts in the liver to prevetn synthesis of Vitamin K dependnet factors (II, VII, IX, X) by preventing carboxyl group from being added to glutamyl reidicues.

Also inhibits Protein C synthesis - procoagulant effect.

40

Inotropes

Digoxin, dobutaine, milrinone, dopamine

41

Direct Xa inhibitors

Rivaroxaban

Adixaban

Edoxaban

42

Suppression of AV node - CCB

Verapamil > Diltiazem 

NO effect by nifedipine

43

SE of class IV

hypotension, digitalis toxicity

44

what mimics affect of adenosine

ACh on M2 receptors and Vagal maneuvers

45

Elimination of Dabigatran

80-85% renal excretion

Dosage adjustment for renal impairment of CrCl <30

46

Treatment of digoxin toxicity

correct electrolytes, use antiarrthmic drugs, digoxin antibodies

47

Vasocilators on contractility

B blockers decrease the most with verapamil

Nifedipine and diltiazem stay the same or slight decrease

nitrates no effect

48

Adverse Rxs of CCB

cardaic arrect

AV block

CHF

bradycardia

Flushing

Edema, dizzy, N, constipation

49

Parmacokinetics of Reteplase vs. Tenecteplase

Reteplase: 2 doses, 30 minutes apart

Tenecteplase: single bolus

Prolonged duration compared to Alteplase

50

ARB vs ACEI

same effect, but no cough or angioedema. ARB block all AII production mechanisms (non renal ones)

51

Dabigatran overdose

first with antibody for reversal - IDARCUIZUMAB

52

Uses of Ranolazine

Add on for Agina - decrease symptoms of stable, increase exercise tolerance, substitute for beta blockers

53

Digoxin disadvantage in Rate control

does not control rate during exercise

54

Hypokalemia and diuretics

Loop + thia is greatest risk, Thia is lead. AA is hyperkalemia risk

55

use of Class 1b drugs

VT

56

Elimination of Heparin types

UFH, LMWH, Fondarinux, DTI

all except LMWH have short half life of 50-150 minutes and are reticuloendothelial cleared.

LMWH has a longer duration with 1-2 daily dose and Renally eliminated

57

Effects of ACEI

Vasodilation due to decreased AII and increased bradykinin Inhibits cardiac remodeling due to decreased aldosterone production

58

Route of administration of Unfractionated Heparin

IV or SC

IM is not used due to risk of hematomas

oral is not used due to poor bioavaliability

59

AT

atrial tachycardia due to a hotspot in atria

60

Type of drug - Hydrochlordothiazide

Thiazide diruetic - blocks Na/Cl in Distal Convoluted Tubule

61

Type of drug - Verapamil

Class IV, Ca channel blocker

62

Class III main drug

amidoarone

63

ARBs dosing

QD: losartan and candesartan BID: volsartan

64

Type of drug - Encainide

Class 1C Na Channel block - Discontinued

65

Type of drug -Volsartan

ARB

66

Type 4 HF

Congestion and hypoperfusion Cold and wet

67

Abciximab Route and risks

continous IV and risk of bleeding

68

Class II drugs main one

Propanolol, metoprolol

69

Adverse Reactions of Clopidogrel

GI upset, heacahce, dizziness, URI, BLEEDING**

less effect of bleeding than prasugrel

if used with PPI, decreased activation

70

Drug interactions with Ivabradine

CYP3A4 and prolongs QT so proarrhythmic potential

71

AT1 receptors

GPCR with Gq

72

Adverse Rxns of Warfarin

Hemorrhage

necrosis of the fatty tissue

N, V, D< cramping

Osteoporisis

73

Type I HF

Warm and dry

74

Tx differnce in A fibrillation vs. A flutter?

A flutter is treated like A fib, but harder to treat with meds. Catheter ablation is more successful than A fib and is considred curative with no anti-coags

75

AVRT

AV rentry tachycardia through accesory pathway. THis produces a delta wave becase ventricles depolarize before His/Purkinje doe.

76

Adverse rx of Ranolazine

prolong QT but not leading to torsades

77

Type of drug - Enalapril

ACE I

78

Plan for tx of A fib

1) reverse cause 2) rate control 3) anticoag 4) think about rhythm 50 think about ablation

79

Rate control

Class II and IV, digoxin (not in exercise)

80

Enoxapirin

LMWH

81

Coumadin

warfarin

82

main class 1B drug

lidocaine

83

ending for ACE I

PRIL

84

Adverse Rxns of nitrates

vasodilation: throbbing headache, orthostatic hypotension, flushing

Tachyphylaxis (tolerance) with continued exposure due to decreased nitrosothiol groups required for NO formation.

85

Antidromic AVRT

goes down accessory before AVN

86

Pharmacokinetics of Ranolazine

35-55% bioavaliabiligy

P glycoprotein efflux transporters

hepatically eliminated CYP3A4

BID

87

Type 3 HF

Hypoperfusion Cold and dry

88

Type of drug - Sotolol

Class III K channel blocker; with B blocker

89

Adenosine with ST

heart block then back to ST

90

what is the chronic treatment of bradyarrhythmoas?

pacemaker

91

Mechanism of Nitrates

Converted to NO (requires thiol and aldehyde dehydrogease).

NO acts on GC to increase cGMP and cuase relaxation.

Mimics the effect of ACh, bradykinin, histamine

Primary effect: decrease systemic resistance and decrease mycoardial oxygen requirement

secondary: increase perfusion of ischemic myocardium

92

what does adenosine terminate

AVNRT and AVRT

93

Syptomes of influsion of VIT K too fast

dyspnea, chest bain, back pain, death.

 

94

How often should Dabigatran be administered?

BID

has faster action that warfarin (2-3 days)

But missed does leads to thrombosis

95

Warfarin Overdose

Bleeding (hematuria, excessive menstruation, gum bleeding)

Therapeutic level < INC < 4.5 with no bleeding --> hold 1doses

INF =4.5-10 - not bldding - hold 1-2 doses

INR >10 but not bleeding: hold warfin and administer Vit K

Major bleeding: hold warfin and 5-10mg of Vitamin K

Prothobmin complex can be administered or VIIa factor but not Fresh frozen plasma

96

where do each diuetics act in the kidney?

loop - Trasnverse Ascending limb on Na/K/Cl transporter Thiazide distal convoluted tubule on Na/CL transpoter AA: in collecting tubute on Na/K/H transporter

97

Mechanism of Aspirin

Inhibition of COXI to decrease circulating levels of Thromboxame A2 (greater relative to COX2 prostaclycin synthesis).

Net effect: decrease clot formation

98

Adenosine to Junctional rhythm

nothing or termiante

99

SE of Aldosterone antagonists

Hyperkalemia and gynecomastia

100

Type of drug - Dopamine

Inotope - NE precursor

101

SE of entresto

angioedema

102

Rhythm control in atrial fibrillation

Class III, IC (not very good) Shock Catheter ablation

103

Tenecteplase - type and mechanism

fibrinolytic agent

binds to fibrin and plasminogen activating

Prolonged duration ofa ction compared to Altepase

More specific than Reteplase

104

105

First step in treating regalar tachyarrhythmias?

adenosine to diagnose or terminate. Terminates those involving the AV node by shutting off the AV node.

106

Type of drug - Carvedilol

Beta Blocker Class 2

107

Type of drug -Spironolactone

Aldosterone Antagonist/K Sparing diruetic; acts on Na/k/H transporter in Collecting Tubue

108

Inotropes tachyarrhythmia potential

NE>Dopamien>dobutamine>milrinone

109

contraindications of ACEI

pregnancy, bilateral renal a. stenosis, hyperkalemia

110

Route of adminitartion of Dabigatran

Oral prodrug that is activated in plasma and liver

111

Reteplase - type and mechanism

Fibinolytic agent

modified form of tPA that has prolonged duration of action.

Less fibrin specific than tenecteplase

binds to fibrin to activate plasminogen

112

Supression of SA node CCB

Diltiazem = verapamil > Nifedipine

113

Warfarin Contraindications

PREGNANCY!

hypersensitivty

thrombocytopenia

hemophilia

severe hypertension

bacterial endocarditis

114

main class 1C drug

fecidine and propafenone

115

Drug interactions that increase effects of warfarin

Increase pharmacokinetic: amiodarone, cimetidine fluconazole, fluoxetine, metronidazole, rosuvastatin

Increase pharmacodynamic (increase function): high dose aspirin, oral antibiotics

116

Type of drug - Ibutilide

class III K channel blocker

117

Prasugrel - mechanism

ADP receptor antagonists to decrease platelet aggregation

118

Inotropes HRincrease

NE>Dopamien>dobutamine>milrinone

119

Epifibatide route and risk

continuous IV and bleeding

120

ending for ARBs

ARTAN

121

Uses of Dabigatran

Decrease Stroke and systmic embolism in non-valvular A fib. (NOT VTE)

A fib

122

hydralazine

vasodilator. Promotes hyperpolarization, inhibits IP3 release of Calcium, and stimulated formation of NO by vascular endothelium. Used on patients with persistent symptoms to decrease afte rload, work and regurgitation.

123

Side effects for Class 2

bradycardia, hypotension, AV block

124

Adverse reactions for Unfractionated Hemparin

Hemorrhage*

Hypersensitivity

THrombocytopenia (mild is normal for 4 days, but severe is longer than 5-10 days).

Osteoporosis if used for longer than 6months

125

use of adenosine

SVTS with AV nodal reentry

126

Contraindications of Heparin

Hypersensitivity

Thrombocytopenia***

hemophilia

active bleeding

severe hypertension

bacterial endocarditis

ulcers/GI

127

Treatments of AVNRT, ARVT, AT

adenosine for AVNRT and AVRT NOT AT Meds for all if Chronic: beta blockers, IV, I Cathetheter ablation for all

128

Contraindications of ARBs

pregnancy, high uric acid producers, hyperkalemia, rental A. stenosis

129

Uses of Warfarin

A fibrillation (nice becuase it can be reversed with vitamin K, but there is incredible dosage variablity, dietary restrictions, monitoring, drug interactions).

Prophylaxis of VTE especially with prosthetic valves

130

ARBs

selective inhibition of AT1 receptor to cause vasodilation (but less than ACEI no kinin)

131

Short acting Nitrates

Nitroglycerin and isosorbide dintrate sublingual

Nitroglycerin 10-30 minutes

Isosorbide dinitrate 10-60 minutes

132

Adverse Rxns of Dabigatran

Bleeding

GI: dyspepsia, gastritis

NOT GYP450 eliminated so no drug reactions

133

Tirofiban route and risk

Continuous IV and bleeding

134

what triggers late afterdepolarizations

Increased Ca due to ischemia, stress, digoxin toxicity, to activate NCX which leads to depolarization

135

Factor II , VII, IX, X turnover rates

VII (6 hr)>IX (24 hr)>X (40 hr) > II (60 hr)

136

Type of drug - Candesartan

ARB

137

how shoudl ACEI be started?

with or after diuretics, low and titrate up

138

Unfractionated Heparin - type

anticoagulant

139

Class IV

L type Ca Channel blocks to decrease activation slope and increase refractory in node. Use dependent

140

Metabolism of Warfarin

99% plasma protein bound

CYP2C9 metabolism in liver

141

Uses of LMWH

used for same causes as unfractionated heparin

unstable angina or Acute MI

Prophylaxis fo VTE or post op TE

Prevent cerebral thrombosis

BUT does not require monitoring due to less complications with bleeding and thrombocytopenia

142

Adenosine to Atrial Flutter

CHB to flutter

143

what meds trigger bradyarrhythmias

Beta blockers, Calcium blockers, Anti-arrythmic, Clonidine, lithium

144

Use of Class Ia drugs

A fib and flutter, SVT

145

SE of dobutamine

Angina, tachy, dysarhythmia

146

Elimination of LMWH

longer duration that other types of heparin

only 1-2x daily dosing

Renally eliminated

147

what drugs trigger bradyarrhythmias?

Beta Blocks and Class IV, lithium, clonidine

148

What Class are use dependent

I and IV

149

Acute treatment of bradyarrhythmias

IV dopamine, IV isoproternolol, pacemaker

150

Treatement process of Bradyarrhythmias

1) Treat cause - ischemia, hypothyroidism, Lyme 2) Stop offending meds 3) Acute Tx if unsable with IV Beta-Agonists and transcutaneous pacing 4) Chronic: Pacemaker

151

Type of drug - Lisinopril

ACEI

152

Adverse Reactions of the LMWH

Hemorrhage

Hypersensitivity

THrombocytopenia (but less than unfractionated heparin)

Osteoporsis with >6 months use

153

Admiodarone

Class III - with a long half life! also has class I effect and decreases slope of phase 4 SE: bradycardia, AV block, pulmonary fibrosis, hypothyrodism

154

Dipyridamole - mechanism and type

antiplatelet

Blocks phosphodiesterase to block cAMP breakdown.

This increases prosatcyclin activity.

NOT antithrombic

155

Meds for V Tach

Amidonarone, Lidocaine, Procainamide, Beta block, Calcium blocks

156

use of class 1c drugs

SVT and VT

157

Uses of CCB

Angina

Cardiac arrhyth ias

Hypertension

subarachnoid hemorrhage (nimodipine)

Premature labor (nifedipine)

158

Routes of the various kinds of Heparins:

UFH, LMWH, Fondarinux, DTI

all are IV or SC.

NOT IM or ORAL

159

When should you treat bradyarrhythmias?

when they are symptomatic or infranodal - like in type 2 secondary AV block or 3rd degree AV block.

160

When is an ICD necessary?

in chornic V-tach that shows structrual changes and is life treatening. when EF <35% or <35-40% with inducible VT or with hypertrophic CM, Congeital defects

161

Vasodilation effect of CCB

Nifedipine > Verapamil > diltiazem

162

Elimination of direct Xa inhibitors

Rivaroxaban: CYP3A4 (65%) + renal

Adixaban: CYP3A4 (50%) + renal

Edoxaban:high renal elminiation; not for CrCl >95

163

Type of drug - Quinidine

Class Ia anti-arrhythmia: Na Channel Block

164

Type of drug - Torsemide

Loop Diuretic - blocks Na/K/Cl in transverse ascending loo

165

Type of drug - Phenytoin

Class 1B: Na Channel block

166

SE of hydralazine

Lupus like syndrome

167

what drugs inhibit cardiac remodeling

AA, Bblockers, ACEI

168

Type of drug - Propafenone

class 1C Na Channel Block

169

Contraindication so Ivabradine

pregnancy, A fib, AV block, low BP or HR, liver failure

170

Pharmacokinetics CCB

variable oral absorption

>90% protein bound

CYP450 metabolism

171

Difference between generations in Beta blockers

1: nonselective for beta 2: selective for beta 1, 3: alpha

172

how to control rate in atrial fibrillation

1) cardiovert when hemodynamically compromised 2) Meds - Beta blockers, Digoxin, Calcium blockers, Amidoarone

173

Class 2 effect on ion channels

inhibit If, Ica and K

174

Entresto

Valsartan (ARB) with Neprilysin inhibitor - so is vasodilator and decreases conversion of BNP into inactive fragments. This promotes decrease in BP, and naturesis.

175

Special notes about heparin

does not cross the placenta

drug of choice for antiplatelet in pregnancy!

176

Treatment of heparin overdose

Protamine

<50 mg/10minutes

177

Type of drug - Lidocaine

Class 1b: Na Channel Block

178

Type of drug - Ivabradine

New drug - lowers HR but not contraction (inotropy)

179

How often is Unfractionated Heparin administered

IV loading dose

with SC, there is a peak within 2-4 hours

Usually continous IV is perferred

180

Digoxin

inotrope that is used to control symptoms by inhibiting Na/K ATPase to decrease NCX function and increase intraceullar Ca to increase contractility. Also plays a role in baroreceptor expressions.

181

when does warfarin have max effect

3-5 days

182

Pharmacokinetics of Dipyradimole

Oral 3-4 QD before meals

183

AVNRT

AV nodal Rentry tachy where Atria and ventricles depolarize at same time

184

Main Class 1A drug

quinidine

185

Epifibatide - type and mechanism

blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.

Blocks all platelet activation pathway

Antiplatelet

186

Aggrenox

Combination of dipyridamole with aspirin

BID

187

Left ventricular volume effect of vasodilators

Beta block increases

Nitrates decrease the most

All CCB say same or slight decrease

188

what decreases digoxin effectivity?

rifampin, st. johns wort

189

what triggers early depolarizations?

Increased ICa-L

190

Ticagrelor - mechanism

ADP receptor antagonists to decrease platelet aggregation

191

Irregular tachyarrhythmias

A fib, mutifocal tachy arrh, A flutter

192

Pharmacokinetics of Ticagrelor

Prodrug activated by CYP450

Reversible inhibitor that is administerd orally BID with meals

193

Ivabradine

lowers HR but not contraction by decrease If in SA node.

194

Type of drug - Milrinone

Inotrope - Phosphodiesterase inhibitor to decrease cAMP hydrolysis

195

Clopidogrel - mechanism

ADP receptor antagonists to decrease platelet aggregation

196

Systpic Pressure vasocialtors

Nifedipine decrease the mos

then all else are equal

197

Type of drug - Digoxin

Inotrope - blocks N/K ATPase and controls baroreceptor concentrations

198

Class IV main drug

verapamil, Diltiazen

199

Fibrinolytic Agents

Alteplase

Reteplase

Tenecteplase

200

Type of drug - Entresto

new drug - and ARB ( Valsartan) + Neprilysin Inhibitor

201

ENDING FOR DIURETICS

IDE

202

Dabigatran  - other names, mechanism and type

Pradaxa

Anticoagulant

Direct thrombin II inhibitor of Free and Clot bound thrombin

203

Class 1 - Na Channel block (A vs. B. vs. C)

slower depolarization 1C>1A>1B

204

what drugs have increase risk of hyperkalemia?

AA, ACEI, ARBs

205

Unfractionated Heparin - mechanism

indirectly activates antithrombin III to inhibit the actions of IIa and Xa

206

What exacerbates digoxin toxicity?

Class Ia and IV antiarrhthmics, Azole antifungals, macrolides

207

Drug interactions of Heparin

Increased bleeding with Anti-platelet aggregation:

Aspirin

Andomethacin

Ibuprofen

Dextran

208

Loop diuretics cause what ion loss?

K, H, Ca, MG, Urate

209

Risk Factors for Heparin types

All cause hemorrhage

RIsk of Hypersensitivity due to beef and pork origin

Thrombocytopenia

UFH>LMWH; no risk with fondarinux

Osteoporsis with extended use (>6 months)

210

Long acting nitrates

Nitroglycerin oral sustained 6-8 hrs

Nitroglycerin ointment 3-6 hours

nitroglycerin slow release buccal 3-6 hurs

Nitroglycerin slow release transdermal 8-10 hours

Isosorbide dintrate oral 4-6 hours

Isosorbide mononitrate 6-10 hours

211

Uses of Unfractionated Heparin

Adjunct treatment for unstable angina or acute MI

Prophylaxis for VTE (DVT/PE) or Post-Op TE

Prevent cerebral thrombosis

212

Thaizides cause what ion gain?

Ca and urate

213

Abciximab - type and mechanism

blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.

Blocks all platelet activation pathway

214

SE Of ACEi

Dry cough hypotension Angioedema hyperkalemia decreased renal function

215

Elimination of Unfractionated Heparin

T1/2 = 50-150 minute

Reticulo-endo clearance

216

Class III

K channel blockers to delay repolarization and prolong action potential; not use dependent

217

Treatment of V Tachyarrhythmia

if unstable shock, tx underlying cause and meds if stable, meds and tx underlying cuase

218

Adenosine action

binds to A1 to activate Gi to hyperpolarize membrane decreases HR and conduction rate specifically at AV node.

219

Tirofiban - type and mechanism

blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.

Blocks all platelet activation pathway

Antiplatelet

220

Uses of Direct Xa inhibitors

Prevent DVT in hip and knee replacement

Decrease stroke/embolis in non-valvular A fib.

A fib

Rivaroxaban: prevent VTE, and treatment of DVT/PE

221

Type of drug - Procainamide

Class Ia: Na channel block

222

Warfarin Route

Oral (100% abosrobed)

But with delayed effect due to factor turnover

223

Adverse Reactions of Apirin

Rare with low doses

Dyspepsia, N, V, GI bleeding

224

Type of drug - Dobutamine

Inotrope - Beta-agonist

225

Fondarinux Route

IV or SC

226

what is the acute treatment of bradyarrythmias?

Beta agonists - IV dopamine Transcutaneous pacing

227

Type of drug - Amidoarone

Class III K channel blocker with Class I effect

228

Advere Reactions of Direct Xa inhibitors

Bleeding

anticoagulation effect diffucl tto reverse

229

CLASS 1

use dependent Na blocks; decrease contractile velocity, increase refractory to decrease re-entry. Use dependent

230

Adverse Rxns with Prasugrel

GI upset, heacahce, dizziness, URI, BLEEDING**

more effect of bleeding than clopidogrel

if used with PPI, decreased activation

231

decrease effect of warfarin - drug reactions

Increase metaboism: barbituates, carbamazpine, phenyton, rifampin, st johns wort

Decreased absorption: cholestryramine, colestipol

Pharmacodynamic: vitamin K

232

Aldosterone antaonists vs. other diuretics

K sparing diuretic to inhibit Na reabosprtion, but promote K and H reabsorption. and it is also antiremodeling.

233

Inotropes vasodilation potential

Milrinone>Dobutamine>dopamine>Ne

234

Short acting dihydropyridines

increase angina- avoid them!

235

Digoxin toxicity

Above 1.2 ng/ml

Hypokalemia, hypercalcemia, Hypomagnesium

GI: N,V, D,

CNS: disorientation, hallucination, visual changes Gynecomasita

cardiac: bradycardia, Heart block, arrhythmic

236

Mechanism of Action of LMWH

binds directly to Antithrombin III to inactivate Xa (not so much IIa)

237

Dopamine

dose dependent - increase inotropy, pressor and renal function.

238

Type of drug - Losartan

ARB

239

what to do with unstable tachyarrhytmic patient?

shock!

240

Adverse Reactions of firbinolytic agents

Hemorrhage due to lysis of thrombi or systmic formation of plasmin to destroy fibrinogen, and factors V and VIII

 

Intracranial hemorrhage

241

Speical notes about Warfarin

Genetic polymorphisms exist!!

242

Route of administration of nitrates

Oral (sustained release): low oral bioavaliability due to first pass metabolism -> requires higher dose every 4-8 hours.

Exclusion is isosorbide mononitrate

Sublingual: to cause rapid relief in 45 sec to 5 minues. Lasts for less than 30 minutes. Can repeast 3X every 5 min if no relief

Trasndermal: QD for 24 hour (remove at night)

243

what arrhythmia is terminated by adenosine or vagal manuever?

AVNRT AVRT

244

Type of drug -Epierenone

Aldosterone Antagonist/K Sparing diruetic; acts on Na/k/H transporter in Collecting Tubue

245

Type of drug - Adenosin

Anti arrhythmic - non classifed

246

Nitrate- Drug names

Ntiroglycernin

Isosorbide Mononitrate

Isosorbide Dinitrate

247

Type of drug - Flecinide

Class 1C Na Channel Block

248

Rhythm control

III or IC, shock, catheter ablation

249

Chronotropic incompetence

malfunction of SA node to not reguarly increase HR during exercise

250

Side effect of Dipyridamole

Minimal

Dizzy, GI distress

251

Primary VT treatment?

cardioabaltion and meds

252

Route of Direct Xa inhibitors

Orally

Rivaraoxaban QD

Adixaban BID

253

when should aldosterone antagonists be used?

when LVEF is less than 30% or after ACEI and B blocker is ineffective.

254

Prasugrel - pharmacokinetics

prodrug activated by CYP450

irreversible inhibitor

QD orallys

255

Pharmacokinetics of Clopidogrel

Produg that is activated by CYP450 that acts as an irreversible inhibitor.

QD orally

 

256

hypokalmeia

increased HR and AP duration, increase sensitivity to Class III results in U waves and digoxin tocity

257

Quinidine - Side Effects

promotes digitalis toxicity due to inhibitiion of P glycoprotein to lead to torsades de pointes and VT.

258

Orthodromic AVRT

goes down AVN before accessory

259

Type 2 HF

Congestion Warm and west

260

what drugs decrease digoxin metabolism?

quinidine, verapamil, diltiazen

261

Beta blocker dosing

Metaprolol, bisoprolol are both QD Carvedilol: BID

262

Type of drug - Bisprolol

Beta-Blocker Class 2

263

Alteplase - Type and mechanism

Fibinolytic agent

Human Tissue plasminogen activator (tPA)

binds to fibin to activate plasminogen - clost selective

264

Adverse Rxns with Ticagrelor

GI upset, heacahce, dizziness, URI, BLEEDING**

if used with PPI, decreased activation

265

Thiazide vs. Loop diuretics Ca

Ca is excreted in loop, but retains in thiazides via parathyroid hormone.