cvs drug lol Flashcards

Question

guideline for chronic coronary syndrome

Answer 1

1st step BB or CCB 2nd step BB + DHP-CCB 3rd step add 2nd line drug - **ivabradine**: HR lowering by selective inh SA node / metabolize via CYP3A4 / SE → bradycardia AF / contraindication → acute decompensate HF, AV block, resting HR < 60, severe liver impair, pacemaker dependence - **nicorandil**: systemic venous and coronary vasodi + stimulate ATP-sensitive K channel / SE → nv, severe oral intestinal mucosal ulceration - ranolazine: selective inh of late inward sodium current / metabolize via CYP3A4 / SE → dizzy, nausea, constipation / ** QT prolong

Answer 2

คิดว่าไม่น่าออก ถ้าออกมาเติมละกัน

Answer 3

**IA: quinidine**, procainamide, disopyrimide / เพิ่ม AP, ERP, QT, กก K channel blocking / used in arrhythmia esp reentry and ectopic svt & vt / ADR → cinchonism (quinidine), SLE-like (procainamide), HF (disopyramide), thrombocytopenia, torsade de pointes / caution and contrain → LVH, HF (diso qui), QT prolong (procain) **IB**: lidocaine, mexiletine, +/- phenytoin / ลด AP duration, affect ischemic & depolarize purkinje and ventricular tissue / used in acute ventricular arrhythmia (esp post MI), digitalis induce arrhythmia / ADR → CNS stimulate or depress, CVS depress **IC**: flecainide, propafenone / prolong ERP in AV node and accessory bypass tracts / used in SVT inc AF, last resort in refractory VT / ADR proarrhythmia esp post-MI (contrain!) / contraindication → structural heart disease, ischemic heart disease

Answer 4

like class I → block sodium channels at rapid pacing frequency / like class II → antisym / like class III → AP ยาว, block K channel / like class IV → negative chronotropic effect action: negative inotropic effect, vasodi ADR: **amiodarone** → torsade, pulmonary toxic, hypothyroid, hepatic toxic, corneal deposit, optic neuropathy, skin discolor / dofetilide → torsade / sotalol → torsade, CHF, bradycardia, hypotension, COPD exacerbate, bronchospasm / dronedarone → exacerbate of advance HF contraindication: prolong QT (dofe), LVH (dofe sota), advance HF (drone)

Answer 5

action: slow AV nodal conduction, interrupt reentry pathway through AV node, restore normal sinus rhythm in patients with Paroxysmal SVT inc one ass w WPW syndrome

Answer 6

- heparin: bind to antithrombin III ทำให้ thrombin → inactive clotting factor (IIa IXa Xa) / lipidemia clearing effect, direct anticoag, dont cross blood-placenta / ADR: **bleeding**, **thrombocytopenia**, hypersen, alopecia, osteoporosis / antidote: protamine sulfate / monitor: **aPTT** accept at 2-3 times normal value - LMW heparin: ทำให้ Xa → inactive factor X by antithrombin / no lab monitor require exp renal insuff, obesity, preg / lower thrombocytopenia & bleed ถ้าเทียบกับ heparin / drug: nadroparin enoxaparin dalteparin - fondaparinux: no monitor require / **cant using protamine as antidote**

Answer 7

- **hirudin**: direct thrombin inh / used in pt w heparin-induced thrombocytopenia (**HIT**) and ass thromboembolic disease / monitor aPTT: accept 1.5-2.5 times normal range - bivalirudin: direct thrombin inh / for pt w or at risk of HIT, undergoing coronary angioplasty - argatroban: direct thrombin inh / in pt w or at risk of thrombocytopenia, HIT, undergoing PCI / monitor aPTT: accept 1.5-3 times normal range

Answer 8

- vitK anta / act on VKORC1 → inh reduction of vitK epoxide → inh gamma-carboxylation of glu in factor 2 7 9 10 (พูดง่าย ๆ คือ inh clotting factor ในตับ sooo easily bleed โคตร ๆ) แตตตต่ ถ้าในคนที่มี VKORC1 น้อย ก้ลดโดสลงได้ (less VKORC1 inh require for anticoag :)) - act only in vivo, delayed onset on action until depletion of performed clotting factors - antidote: parenteral vitK1 (phytonadione) - protein binding 99% → กระทบโปรตีนนิดนึงคือเกินโดสได้เลย ดังนั้น high DI ! - metabolized by **CYP2C9**: CYP2C9'1 (normal ppl), CYP2C9'2/3 (poor metaboliser) ยาถูกขับลดลงเลยต้องลดโดสที่ให้ - cross placenta = in 1st tri is teratogenic (dont give to preg) - monitor by PT and adjust to INR (INR should be within 2.5-3.5) - DI: **เพิ่ม anticoag** → ABX (reduce vitK absorption), salicylate (displacement plasma protein), allopurinol metronidazole (inh hepatic biotransform), aspirin clopidogrel (inh plt aggregate), quinidine (reduce clot production) // **ลด anticoag** → barbiturate rifampicin (induction of metabolic enz), vitK contraceptive (enhance clot production) - ADR: bleeding, teratogen (dont use in preg), cutaneous necrosis (ไปลด protein C, S) - factor affecting activity of warfarin โดยรวม ๆ: dietary e.g. vitK fat, GI and liver disease, preg, hyperthyroid, NS

Answer 9

- dabigatran etexilate: direct thrombin inh / indication: prevent thrombosis after hip or knee replacement, DVT, PE, embolism prophylaxis in non-vulvular AF / antidote: **idarucizumab** ใช้เมื่อ urgent makk such as uncontrolled bleeding - rivaroxaban: direct factor Xa inh (เปน competitive reverse anta of active Xa) / indication: DVT prophylaxis, thromboembolism, reduce risk of stroke and systemic emboli in non-vulvular AF, reduce MI CAD PAD เมื่อใช้คู่กับ aspirin / antidote: andexanet alpha / pros → rapid therapeutic effect, no monitor, fewer DI / cons → short T1/2 แม้จะให้ยาแต้ก้เสี่ยงที่จะเกิด thromboembolism อยู่ดี

Answer 10

- prevent thrombosis → prevent stroke, MI in CAD - therapeutic use จำนะะ น่าออก: 2nd prevention in vascular event พวก angina งี้ → ASA clopidogrel / ischemic heart disease → ASA clopidogrel heparin / PCI & stent insertion → abxicimab tirofiban eptifibatide - รวมแฟค: aspirin can protect risk of occlusion vascular, clopidogrel มักใช้แทนใน aspirin-contraindicated pt, add 2nd antiplt ต่อจาก aspirin อาจช่วยได้ในบางกรณี e.g. after PCI

Answer 11

1. plt COX inh (aspirin): non-selective COX (TXA2), irreverse inh plt aggregate / ADR: GI irritate, bleed, anemia / low dose 2. P2Y12 anta (5 ตัว): ticlopidine (prodrug) / **clopidogrel** (prodrug) → convert to active form by **CYP2C19**, reduce risk of stroke MI ในคนที่เคยเป็นแล้ว (2nd prevention) / prasugrel (prodrug) → by CYP3A4 CYP2B6, caution in ppl<60kg or renal impair, contrain in hx of cerebrovascular disease / **ticagrelor** → reduce thrombotic risk in ACS pt, metabolized by **CYP3A4**, ADR: dyspnea bleeding, contrain in active pathological bleed or hx of intracranial bleeding / cangrelor 3. phosphodiesterase III enz inh (dipyridamole, cilostazol เน้นตัวนี้): metabolized by CYP3A4>CYP2C19 / indication: increase claudication, stroke / contrain: CHF 4. plt GPIIb/IIIa anta (3 ตัว): prevent fibrinogen bleeding / abciximab → used in PCI / eptifibatide→ กก heptapeptide, ใช้มาก bleed / tirofiban 5. PAR-1 anta (vorapaxar): indication → reduction of thrombolytic in MI & arterial disease / ADR: bleed

Answer 12

- ให้ทันทีที่ MI แต่ถ้าให้มากไปจน toxic อาจ hemorrhage - 1st gen: plasminogen activation / drug: streptokinase ฮิตกว่า, urokinase - 2nd gen: activate plasminogen in fibrin domain = clot selective จะช่วยลด bleed ได้ / drug: alteplase, anistreplase - 3rd gen ฮิตสุดสุด: longer T1/2, resistance to plasma protease inh, selective binding to fibrin, drug: tenecteplase (reduce AMI mortality), lanoteplase, reteplase, monteplase, pamiteplase

Answer 13

- compete for lysine binding site on plasminogen and plasmin → inh fibrinolysis - used in bleeding from fibrinolytic drug therapy (indication หลักคือใช้เปน antidote) - drug: EACA, tranexamic acid (ตัวหลังใช้ได้ใน various bleed e.g. hemorrhage following prostatectomy, dental extraction, menorrhagia

Answer 14

- TC (total CHO) < 200 mg/dl - LDL - C < 130 mg/dl - HDL - C > 40 mg/dl - TG < 150 mg/dl

cvs drug lol Flashcards

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