CVS Pharma

Question 1

Digoxin- Intro, PK, Actions, Adverse effects, Uses.

Answer 1

Digoxin is a Cardiac glycoside obtained from the plant Digitalis lanata. It is an inotropic agent, which increases cardiac contractility and output without concurrently increasing HR

PK: 
Half life= 40 hrs
PPB= 25%
Therapeutic dose= 0.5-1.4 ng/ml
Toxic dose= >2ng/ml
Therapeutic index= 1.5-2
Route of adm= oral or iv ,Route of elimin= Renal 

Actions:
1. Cardiac: increases force of contraction, decreases HR by direct, vagomimetic and antiadrenergic action.
Decreases APD, increases ERP. Decreases conduction velocity through AVN. ECG changes include T-wave flat/inversion, PR prolongation, QT shortening, ST segment depression.
2. Kidney: Diuresis d/t improved perfusion
3. CNS: Stimulation of CTZ at high doses— nausea,vomiting. Higher doses produce CNS disturbances.

Adverse effects:

• Cardiac: Any type of arrythmia (m/c= bigeminy), AV block and bradycardia
• Extracardiac: GI upset, CNS disturbances, Skin rashes and gynaecomastia

Uses:

• A.fib and AFl - maintain Vent rate
• CHF (with low EF)
• PSVT- when accompanied by CHF

Question 2

Outline management of unstable angina.

Answer 2

Unstable angina is an Acute Coronary Syndrome (ACS), occuring due to rupture of an atherosclerotic plaque, causing thrombosis and progressive occlusion of coronary artery.
-It requires aggressive therapy with combination of drugs to prevent further occlusion, to improve myocardial perfusion and decreasing myocardial stress.

1. Antiplatelet drugs: Low Dose Aspirin, Clopidogrel, Prasugrel are used. GPIIB/IIIA receptor antagonists (eg Abciximab) be useful in severe ACS
2. Anticoagulants- LMWH, Unfractioned heparin
3. Nitrates - Sublingual GTN given first. If no relief occurs after 3 tablets at 5 min intervals, IV infusion is started. BP should be monitored during iv
4. Beta blockers- (Metoprolol/Atenolol) Routinely given in unstable Angina unless contraindicated.
5. Statins - Improve outcome in UA

Question 3

Antihypertensives save in pregnancy.

Answer 3

Better Mother Care During Hypertension

Beta blockers (labetalol)
Methyldopa (DOC)
Clonidine, CCB
DHP (discontinued before labor)
Hydralazine

Question 4

Neprilysin inhibitor: Name of drug, MOA, Uses, side effects.

Answer 4

Sacubitril is a Neprilysin or NEP inhibitor.

MOA: inhubits degradation of natriuretic pepides ANP, BNP and other vasodilator peptides like Bradykinin, substance P etc —> natriuretic, diuretic and vasodilator effect, decrease in Ang 2 and aldosterone —> decreased preload, afterload, circulating volume —> improved Left ventricular function

Use: Along with ARB Valsartan for Class 2 and class 4 Congestuve heart failure.

Side effects: Hypotension, Hypokalemia, Angioedema.