CVS pharmacology

Question 1

what is an ionotrope?

Answer 1

an ionotrope is an agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions.

Positively inotropic agents increase the strength of muscular contraction.

Question 2

what is a chronotrope?

Answer 2

chronotropes are agents that change the HR. chronotropic drugs may change the HR by affecting the nerves controlling the heart, or by changing the rhythm produced by the sinoatrial node.

Positive chronotropes increase heart rate

negative chronotropes decrease heart rate.

Question 3

what is a dromotrope?

Answer 3

A dromotrope is an agent that affects AV nodal conduction.

A positive dromotrope increases AV nodal conduction.

A negative dromotrope decreases AV nodal conduction.

Question 4

what is lusitropy?

Answer 4

lusitropy is myocardial relaxation. A lusitrope affects diastolic relaxation.

catecholamines are positive lusitropes, they incr. rate of relaxation

negative lusitropy is due to:

1. Ca²⁺ overload
2. reduced rate of Ca²⁺ removal through Ca²⁺ ATPas and/or Na⁺/Ca²⁺ exchanger
3. impaired sarco-endoplasmic reticulum Ca²⁺ ATPase

Question 5

What are the 5 classes of antiarrhythmic drugs?

Answer 5

1. Class 1- sodium channel blockers
2. Class 2- ß-blockers
3. Class 3- potassium channel blockers
4. Class 4- calcium channel blockers
5. Class 5-other

when treating start with class I and ascend as needed

Question 6

What are the class I antiarrhythmics (sodium channel blockers)?

Answer 6

Procainamide

Quinidine

Disopyramide

Lidocaine

Mexiletine

Phenytoin

Flecainide

Propafenone

Question 7

Class: Class IA antiarrhythmic

MOA: it blocks Na⁺ channels slowing the upstroke of the AP, slowing conduction, and prolonging the QRS duration of the ECG. it decreases ventricular conduction (incr. QRS interval on ECG) and prolongs ventricular AP (incr. QRS interval on ECG)

it has ganglion blocking properties that decr. peripheral resistance, but these effects are not very prominent

Use: treats atrial and ventricular arrythmias

Route of admin.: oral, IV, and IM

Toxicity: drug-induced lupus and induction of torsades de pointes arrythmia and syncope (shown). rare side effect is hypotension due to excessively rapid infusion or left ventricular dysfunction.

what is the drug?

Answer 7

Procainamide

Procainamide is a Class IA antiarrythmic.

Procainamide: blocks Na+ channels slowing the upstroke of the AP, slowing conduction, and prolonging the QRS duration of the ECG. it decreases ventricular conduction (incr. QRS interval on ECG) and prolongs ventricular AP (incr. QRS interval on ECG)

Procainamide can be prescribed to pts w/ atrial arrythmia and/or ventricular arrythmia

Procainamide side effects are: drug-induced lupus and torsades de pointes arrythmia and syncope. rare side effect is hypotension due to excessively rapid infusion or left ventricular dysfunction.

torsdaes de poites is polyventricular tachycardia

Question 8

Class: Class IA antiarrhythmic

MOA: it blocks Na⁺ channels decreasing ventricular conduction (incr. QRS interval on ECG) slowing upstroke of the AP, prolonging ventricular AP (incr. QRS interval on ECG). it also blocks K⁺ channels prolonging the ventricular AP (incr. QRS interval on ECG)

Use: treats atrial and ventricular arrythmias

route of admin.: oral, IV

toxicity: cinchonism (a syndrome of headache, dizziness, and tinnitus) and torsades de pointes (pictured)

what is the drug?

Answer 8

Quinidine

Quinidine is a Class IA drug

MOA: Quinidine blocks Na+ channels decreasing ventricular conduction (incr. QRS interval on ECG) slowing upstroke of the AP, prolonging ventricular AP (incr. QRS interval on ECG). it also blocks K+ channels prolonging the ventricular AP (incr. QRS interval on ECG)

Qunidine is rarely used, but can be used to treat atrial and ventricular arrythmias

quinidine can be administered via IV or oral

Quinidine toxicity presents as cinchonism (a syndrome of headache, dizziness, and tinnitus) and torsades de pointes (pictured)

Question 9

Class: Class IA antiarrhythmic

MOA: it’s more potent than quinidine. it decreases ventricular conduction (incr. QRS interval on ECG) and prolongs ventricular AP (incr. QT interval on ECG)

Use: treats atrial and ventricular arrythmias

Route of admin.: oral, typical dosage is 150 mg 3 times a day (tid)

toxicity: de novo heart failure due to its negative ionotropic effects, urinary retention, dry mouth, blurred vision, constipation, worsening of preexisting glaucoma, and prostatic hyperplasia in males.

what is the drug?

Answer 9

Disopyramide

Disopyramide is a class IA antiarrythmic

Disopyramid blocks NA⁺ channels. t’s more potent than quinidine. it decreases ventricular conduction (incr. QRS interval on ECG) and prolongs ventricular AP (incr. QT interval on ECG).

Disopyramide is used to treat atrial and ventricular arrythmias

recommended dosage is 150 mg Disopyramide po 3 times a day

Patient w/ disopyramide toxicity may present w/ heart failure, urinary retention, dry mouth, blurred vision, constipation, worsening glaucoma, and prostatic hyperplasia, if male

Question 10

Class: Class IB

MOA: it blocks Na⁺ channels. it slows conduction and increases threshold for firing of abnormal cells. it blocks activated and inactivated Na⁺ channels w/ rapid kinetics. the inactivated state block ensures greatr effects on cells w/ long AP such as purkinje cells and ventricular cells. it increases the repolarization phase. it does NOT affect the QRS complex.

use: treats acute ventricular arrhythmias and arrhythmias associated w/ acute MI

route of admin. : IV

toxicity: CV depression and CNS depression (paresthesias, tremor, nausea of central origin, lightheadedness, hearing disturbances, slurred speech, and convulsions)

what is the drug?

Answer 10

Lidocaine

Lidocaine is a class Ib antiarrhythmic

Lidocaine is a Na⁺ channel blocker. it slows conduction and increases threshold for firing of abnormal cells. it blocks activated and inactivated Na+ channels w/ rapid kinetics. the inactivated state block ensures greatr effects on cells w/ long AP such as purkinje cells and ventricular cells. it does NOT affect the QRS complex.

Lidocaine is used to treat acute ventricular arrhythmias and arrhythmias associated w/ acute MI

Lidocaine is only administered by IV. Lidocaine is one of the least cardiotoxic of the Class I antiarrhythmics (Na⁺ channel blockers). Lidocaine overdose (toxicity) presents as CV depression and CNS depression (paresthesias, tremor, nausea of central origin, lightheadedness, hearing disturbances, slurred speech, and convulsions)

Question 11

Class: class IB antiarrhythmic

MOA: it blocks Na⁺ channels. it slows conduction and increases threshold for firing of abnormal cells. it lengthens the repolarization phase. it does NOT affect the QRS complex.

Use: treats ventricular arrhythmias

route of admin.: oral and IV

toxicity: CNS depression (tremor, blurred vision, lethargy, and nausea)

what is the drug?

Answer 11

mexiletine

mexiletine is a class Ib antiarrhythmic.

mexiletine blocks Na⁺ channels. it slows conduction and increases threshold for firing of abnormal cells. it lengthens the repolarization phase. it does NOT affect the QRS complex.

mexiletine is used to trear ventricular arrhythmias

mexiletine can be given orally or via IV

mexiletine toxicity presents as CNS depression (tremor, blurred vision, lethargy, and nausea)

Question 12

Class: class Ib antiarrhythmic

MOA: it blocks Na⁺ channels. it slows conduction and increases threshold for firing of abnormal cells.

use: treats ventricular tachycardia and paroxysmal atrial tachycardia after other antiarrhythmic agents have failed.

route of admin.: oral

toxicity: drug induced lupus, hirsutism, gingival enlargement, and it’s a teratogen.

what is the drug?

Answer 12

Phenytoin

phenytoin is a class Ib antiarrhythmic

phenytoin locks Na+ channels. it slows conduction and increases threshold for firing of abnormal cells.

it’s used to treat ventricular tachycardia and paroxysmal atrial tachycardia after other antiarrhythmic agents have failed.

it’s given po.

Phenytoin toxicity presents as drug induced lupus, hirsutism, and gingival enlargement. Phenytoin is a teratogen.

Question 13

Class: class Ic

MOA: it blocks Na⁺ channels. it decreases ventricular conduction (incr. QRS interval on ECG).

uses: treats ventricular arrhythmias, paroxysmal atrial fibrillation, and paroxysmal supraventricular tachycardia.

route of admin.: oral

toxicity: it can cause arrhythmias, especially in post-MI patients and drug-induced interstitial lung disease
contraindications: it is contraindicated after MI

what is the drug?

Answer 13

Flecainide

Flecainide blocks Na⁺ channels and decreases ventricular conduction (incr. QRS interval on ECG)

Flecainide treats ventricular arrhythmias, paroxysmal atrial fibrillation, and paroxysmal supraventricular tachycardia.

Flecainide is admitted orally

Flecainide can cause arrythmias, especially in post MI patients, and drug-induced interstitial lung disease.

Flecainide is contraindicated post-MI

Question 14

Class: Class IC

MOA: it blocks Na⁺ channels. it decreases ventricular conduction (incr. QRS interval on ECG).

uses: treats ventricular arrhythmias, paroxysmal atrial fibrillation, and paroxysmal supraventricular tachycardia.

route of admin.: oral

toxicity: it can cause drug-induced lupus like syndrome, CNS disturbances (dizziness), and bronchospasm

what is the drug?

Answer 14

propafenone

propafenone is a Class IC antiarrhythmic

propafenone blocks Na+ channels. it decreases ventricular conduction (incr. QRS interval on ECG).

propafenone is used to treat ventricular arrhythmias, paroxysmal atrial fibrillation, and paroxysmal supraventricular tachycardia.

propafenone is given orally under a doctor’s care while being monitored on an ECG.

propafenone can cause drug-induced lupus like syndrome, CNS disturbances (dizziness), and bronchospasm

Question 15

Class: class II antiarrhythmic

MOA: it’s a ß1 blocker. it decreases AV nodal conduction (incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects

use: treats ventricular and supraventricular arrhythmias

route of admin.: IV

toxicity: bradycardia and AV block (pictured)

what is the drug?

Answer 15

Esmolol

Esmolol is a class II antiarrhythmic

Esmolol is a ß1 receptor blocker. it decrease AV nodal conduction (incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects

esmolol is used to treat ventricular and supraventricular arrhythmias

esmolol can cause bradycardia and AV block (pictured)

Question 16

Class: class II

MOA: it’s a selective ß1 blocker. it decreases AV nodal conduction (incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects

use: treats supraventricular tachycardia (SVT),ventricular tachycardia, HTN,angina, acute MI, congestive heart failure(CHF), and prevention of migraine headaches.

route of admin.: oral

toxicity: bradycardia, AV block (pictured), dizziness, ataxia, problems sleeping, ED, diarrhea, and vision problems

what is the drug?

Answer 16

Metoprolol

metoprolol is a class II antiarrhythmic

metoprolol is a ß1 blocker. it decreases AV nodal conduction (incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects

metoprolol is used to treat supraventricular tachycardia (SVT),ventricular tachycardia, HTN,angina, acute MI, congestive heart failure(CHF), and prevention of migraine headaches.

metoprolol is administered orally

metoprolol can cause bradycardia, AV block (pictured), dizziness, ataxia, problems sleeping, ED, diarrhea, and vision problems

Question 17

Class: class II antiarrhythmic

MOA: it’s a non-selective ß-blocker. it decreases AV nodal conduction( incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects.

use: treats ventricular and supraventricular arrhythmias

route of admin.: oral or parenteral injection

toxicity: bradycardia, AV block (pictured), bronchoconstriction, blunting of hypoglycemic response

what is the drug?

Answer 17

propanolol

propanolol is a class II antiarrhythmic

propanolol is a non-selective ß-blocker. it decreases AV nodal conduction( incr. PR interval on ECG). it reduces HR and contractility by blocking ß1 effects.

propanolol is used to treat ventricular and supraventricular arrhythmias

propanolol is administered orally or parenterally

propanolol can cause bradycardia, AV block (pictured), bronchoconstriction, blunting of hypoglycemic response

Question 18

Class: class III

MOA: it’s a K⁺ channel blocker. it prolongs phase 3 of the ventricular AP (incr. QT interval on ECG). it also shows beta blocker-like and potassium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects. it is chemically similar to thyroxine(T4) and it binds to the thyroxine (T4) receptor. it also causes peripheral vasodilation

uses: treats and prevents ventricular arrhythmias

route of admin.: oral and IV

toxicity: pulmonary fibrosis, hepatotoxicity, thyroid disease, bradycardia, and AV block (pictured)

what is the drug?

Answer 18

Amiodarone

amiodarone is a class III antiarrhythmic

amiodarone is a K+ channel blocker. it prolongs phase 3 of the ventricular AP (incr. QT interval on ECG). it also shows beta blocker-like and potassium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects. it is chemically similar to thyroxine(T4) and it binds to the thyroxine (T4) receptor. it also causes peripheral vasodilation

amiodarone is used to treat and prevent ventricular arrhythmias

amiodarone can be administered orally or by IV

amiodarone can cause pulmonary fibrosis, hepatotoxicity, thyroid disease, bradycardia, and AV block (pictured).

Question 19

Class: class III

MOA: it’s a K⁺ channel blocker. it prolongs ventricular AP (incr. QT interval on ECG). it acts on potassium channels and causes a delay in relaxation of the ventricles. By blocking these potassium channels, it inhibits efflux of K+ ions, which results in an increase in the time before another electrical signal can be generated in ventricular myocytes. This increase in the period before a new signal for contraction is generated, helps to correct arrhythmias by reducing the potential for premature or abnormal contraction of the ventricles but also prolongs the frequency of ventricular contraction to help treat tachycardia.

use: treatement and prevention of ventricular arrhythmias

route of admin.: oral

toxicity: torsades de pointes (due to incr. QT interval) (pictured)

what is the drug?

Answer 19

sotalol

sotalol is a class III antiarrhythmic

sotalol is a a K+ channel blocker. it prolongs ventricular AP (incr. QT interval on ECG). it acts on potassium channels and causes a delay in relaxation of the ventricles. By blocking these potassium channels, it inhibits efflux of K+ ions, which results in an increase in the time before another electrical signal can be generated in ventricular myocytes. This increase in the period before a new signal for contraction is generated, helps to correct arrhythmias by reducing the potential for premature or abnormal contraction of the ventricles but also prolongs the frequency of ventricular contraction to help treat tachycardia.

sotalol is used to treat and prevent ventricular arrhythmias

sotalol is administered orally

sotalol may cause torsades de pointes (due to incr. QT interval) (pictured)

Question 20

Class: class III antiarrhythmic

MOA: it’s a K+ channel blocker.

Question 21

Class: class IV antiarrhythmic

MOA: it’s a Ca²⁺channel blocker. it decreases AV nodal conduction. it blocks activated and inactivated L-type Ca²⁺ channels. it usually slows SA nodal conduction. it decreases O2 demand, HR, and contractility.

use: supraventricular arrhythmias

route of admin.: oral

toxicity: constipation, bradycardia, galactorrhea, gingival hyperplasia, and AV block (pictured)

what is the drug?

Answer 21

verapamil

verapamil is a class IV antiarrhythmic.

verapamil is a Ca²⁺ channel blocker. it decreases AV nodal conduction. it blocks activated and inactivated L-type Ca2+ channels. it usually slows SA nodal conduction. it decreases O2 demand, HR, and contractility.

verapamil is used to treat supraventricular arrhythmias

verapamil is administered orally

verapamil may cause constipation, bradycardia, galactorrhea, gingival hyperplasia, and AV block (pictured)

Question 22

Class: class IV

MOA: it’s a Ca²⁺ channel blocker. it decreases AV nodal conduction. it blocks L-type Ca²⁺ channels. it decreases O2 demand, HR, and contractility. it has negative ionotropic effect which decreases HR, negative chronotropic effect which decreases HR and SA nodal conduction, and negative dromotropic effects which decrease AV nodal conduction.

uses: treats supraventricular arrhythmias

route of admin.: oral

toxicity: constipation, bradycardia, dizziness, hypotension, and AV block (pictured)

what is the drug?

Answer 22

diltiazem

diltiazem is a class IV antiarrhythmic.

diltiazem is a Ca²⁺ channel blocker. it decreases AV nodal conduction. it blocks L-type Ca2+ channels. it decreases O2 demand, HR, and contractility. it has negative ionotropic effect which decreases HR, negative chronotropic effect which decreases HR and SA nodal conduction, and negative dromotropic effects which decrease AV nodal conduction.

diltiazem is used to treat supraventricular arrhythmias.

diltiazem is administered orally.

diltiazem may cause constipation, bradycardia, dizziness, hypotension, and AV block (pictured)

Question 23

Class: class V antiarrhythmic

MOA: it is a nucleoside, it decreases AV nodal conduction. it is a negative dromotrope (negative dromotropes decr. AV nodal conduction).

uses: treats supraventricular arrhythmias

route of admin.: IV

toxicity: flushing, hypotension, diaphoresis (profuse sweating), and chest pain

what is the drug?

Answer 23

Adenosine

Adenosine is a class V antarrhythmic

adenosine is a nucleoside and a negative dromotrope, it decr. AV nodal conduction.

adenosine is used to treat supraventricular arrhythmias/ supraventricular tachycardia (SVT)

adenosine is administered via IV

adenosine may cause flushing, hypotension, diaphoresis (profuse sweating), and chest pain

Question 24

Class: class V antiarrhythmic

MOA: it ‘s a cardiac glycoside. it blocks the Na⁺-K⁺ ATPase resulting in incr. intracellular Na⁺. the high levels of intracellular Na⁺ reduce the activity of the Na⁺-Ca²⁺ exchanger and more Ca²⁺ remains intracellular. the high levels of intracellular Ca²⁺ improve cardiac contractility. it also decrease AV nodal conduction. it is a positive inotrope (it incr. contractility), a negative dromotrope (it decr. AV nodal conduction), it is a negative lusitrope (it decr. activity of the Na+-Ca²⁺ exchanger, incr. intracellular Ca²⁺ levels). it also has some parasymp. activity

uses: chronic heart failure, atrial fibrillation (A-fib), and atrial flutter

route of admin.: oral

toxicity: arrhythmias and blurry yellow vision

what is the drug?

Answer 24

digoxin

digoxin is a class V antiarrhythmic

digoxin is a cardiac glycoside, it blocks the Na+-K+ ATPase resulting in incr. intracellular Na+. the high levels of intracellular Na+ reduce the activity of the Na+-Ca2+ exchanger and more Ca2+ remains intracellular. the high levels of intracellular Ca2+ improve cardiac contractility. it also decrease AV nodal conduction. it is a positive inotrope (it incr. contractility), a negative dromotrope (it decr. AV nodal conduction), it is a negative lusitrope (it decr. activity of the Na+-Ca2+ exchanger, incr. intracellular Ca2+ levels). it also has some parasymp. activity.

digoxin is used to treat chronic heart failure, atrial fibrillation (A-fib), and atrial flutter.

digoxin is administered orally

digoxin may cause arrhythmias and blurry yellow vision

Question 25

Class: class V antiarrhythmic MOA: it 's a cardiac glycoside. it's more potent than digoxin. it blocks the Na+-K+ ATPase resulting in incr. intracellular Na+. the high levels of intracellular Na+ reduce the activity of the Na+-Ca2+ exchanger and more Ca2+ remains intracellular. the high levels of intracellular Ca2+ improve cardiac contractility. it also decrease AV nodal conduction. it is a positive inotrope (it incr. contractility), a negative dromotrope (it decr. AV nodal conduction), it is a negative lusitrope (it decr. activity of the Na+-Ca2+ exchanger, incr. intracellular Ca2+ levels). it also has some parasymp. activity. uses: chronic heart failure, atrial fibrillation (A-fib), and atrial flutter route of admin.: oral toxicity: arrhythmias and blurry yellow vision what is the drug?

Answer 25

Digitoxin. Digitoxin is a class V antiarrhythmic and a cardiac glycoside. digitoxin is more potent than digoxin. digitoxin blocks the Na+-K+ ATPase resulting in incr. intracellular Na+. the high levels of intracellular Na+ reduce the activity of the Na+-Ca2+ exchanger and more Ca2+ remains intracellular. the high levels of intracellular Ca2+ improve cardiac contractility. it also decrease AV nodal conduction. it is a positive inotrope (it incr. contractility), a negative dromotrope (it decr. AV nodal conduction), it is a negative lusitrope (it decr. activity of the Na+-Ca2+ exchanger, incr. intracellular Ca2+ levels). it also has some parasymp. activity. digitoxin is used to treat chronic heart failure, atrial fibrillation (A-fib), and atrial flutter digitoxin is administered orally. digitoxin may cause arrhythmias and blurry vision

Question 26

Class: class V antiarrhythymic MOA: unkown use: treats Torsades de pointes (pictured) route of admin.: IV toxicity: respiratory depression what is the drug?

Answer 26

Mg^2+. Mg²⁺ is a class V antiarrhythmic. it's MOA is unknown. Mg²⁺ is used to treat Torsades de pointes (pictured) Mg²⁺ is administered via IV Mg²⁺ may cause respiratory depression

Question 27

MOA: it inhibits topoisomerases I or II, preventing DNA replication and inducing DNA double-strand breaks. it's often used in combination with other drugs. it's part of ABVD treatment regimen and Stanford V treatment regimen. it's combined w/ ifosamide and mesna to treat angiosarcoma. Cell cycle specific: No it's cell cycle non-specific. Use: angiosarcoma, breast carcinoma, thyroid carcinoma, testicular carcinoma, and lymphoma toxicity: cardiotoxicity. it causes dilated cardiomyopathy what is the drug?

Answer 27

Doxorubicin (AKA adriamycin) doxorubicin is a non-cell cycle specific chemotherapy drug. doxorubicin inhibits topoisomerases I or II preventing DNA replication and inducing DNA double-strand breaks. it's often used in combination with other drugs. it's part of ABVD treatment regimen and Stanford V treatment regimen. doxorubicin is used to treat angiosarcoma, breast carcinoma, thyroid carcinoma, testicular carcinoma, and lymphoma doxorubicin has cardiac toxicity, it causes dilated cardiomyopathy

Question 28

MOA: it's an alkylating agent. it covalently cross-links DNA at guanine N7. it requres activation by the CYP-450 enyme system in the liver. it's combined w/ mesna and doxorubicin to treat angiosarcoma. Cell cycle specific: No, it's not cell cycle specific use: treats angiosarcoma, non-hodgkins lymphoma (NHL), breast, and ovarian cancer. toxicity: hemorrhagic cystitis. it has toxic metabolite acrolein that causes hemorrhagic cystitis. co-admin. of mesna w/ this drug via IV prevents hemorrhagic cyctitis. Another mjr side effect is encephalopathy. other side effects include myelosuppression and extreme nausea. what is the drug?

Answer 28

ifosfamide ifosfamide is an alkylating agent, similar to cyclophosphamide. Ifosfamide covalently cross-links DNA at guanine N7. it requres activation by the CYP-450 enyme system in the liver. it's combined w/ mesna and doxorubicin to treat angiosarcoma. ifosfamide is not cell-cyclespecific. ifosfamide is used to treat angiosarcoma, non-hodgkins lymphoma (NHL), breast, and ovarian cancer. ifosfamide causes hemorrhagic cystitis and encephalopathy. ifosfamide has a toxic metabolite, acrolein, that causes hemorrhagic cystitis. co-admin. of mesna via IV w/ ifosfamide prevents hemorrhagic cyctitis. other side effects include myelosuppression and extreme nausea.

Question 29

it's used as an adjuvant in cancer chemotherapy. it is an antioxidant. route of admin.: IV (w/ ifosfamide) oral (w/ cyclophosphamide) it's co-administered w/ ifosfamide to prevent hemorrhagic cystitis. it can cause an allergic reaction and pink/red colored urine. what is the drug?

Answer 29

Mesna. Mesna stands for 2-MercaptoEthane Sulfonate Na⁺ Mesna is an anti-oxidant and an adjuvant in cancer chemotherapy. Mesna is administered via IV Mesna is co-administered via IV with ifosfamide to prevent hemorrhagic cystitis. Mesna can cause an allergic reaction and pink/red colored urine

Question 30

MOA: it's a vinca (plant) alkaloid. it prevents microtubule formation by interfering w/ tubulin binding. the mitotic spindle can't form and the M phase does not proceed. it's used in combination w/ dactinomycin (actinomycin-D) and cyclophosphamide to treat rhabdomyosarcoma. cell cycle specific: yes, it acts at M phase. use: it's used to treat rhabdomyosarcoma, lymphomas, testicular carcinoma, and small-cell lung carcinoma. toxicity: neurotoxicity (peripheral neuropathy) what's the drug?

Answer 30

Vincristine microtubules are the VINes of the cells (vincristine and vinblasine bind tubulin (microtubules)) Vincristine is a vinca (plant) alkaloid. vincristine prevents microtubule formation by interfering w/ tubulin binding. the mitotic spindle can't form and the M phase does not proceed. it's used in combination w/ dactinomycin (actinomycin-D) and cyclophosphamide to treat rhabdomyosarcoma. vincristine acts at M phase vincristine is used to treat rhabdomyosarcoma, lymphomas, testicular cancer, and small-cell lung cancer. toxicity: neurotoxicity (peripheral neuropathy)

Question 31

MOA: it's an alkylating agent. it covalently cross-links DNA at guanine N7. it requres activation by the CYP-450 enyme system in the liver. it's combined w/ vincristine and dactinomycin (actinomycin-D) to treat rhabdomyosarcoma. Cell cycle specific: No, it's not cell cycle specific use: treats rhabdomyosarcoma, non-hodgkins lymphoma (NHL), breast, and ovarian cancer. toxicity: hemorrhagic cystitis. it has toxic metabolite acrolein that causes hemorrhagic cystitis. co-admin. of mesna w/ this drug orally prevents hemorrhagic cyctitis. other side effects include myelosuppression and extreme nausea. what is the drug?

Answer 31

cyclophosphamide. cyclophosphamide is an alkylating agent. it covalently cross-links DNA at guanine N7. it requres activation by the CYP-450 enyme system in the liver. it's combined w/ vincristine and dactinomycin (actinomycin-D) to treat rhabdomyosarcoma. cyclophosphamide is used to treat rhabdomyosarcoma, non-hodgkins lymphoma (NHL), breast, and ovarian cancer. cyclophosphamide is non-cell cycle specific cyclophosphamide causes hemorrhagic cystitis. it has toxic metabolite acrolein that causes hemorrhagic cystitis. co-admin. of mesna (orally) w/ cyclophosphamide prevents hemorrhagic cyctitis. other side effects include myelosuppression and extreme nausea.

Question 32

MOA: it's an antibiotic. it inhibits transcription. it binds DNA at the transcription initiation complex and preventing elongation of RNA chain by RNAP. it's used in combination w/ vincristine and cyclophosphamide to treat rhabdomyosarcoma. use: it's used to treat rhabdomyosarcoma, gestational trophoblastic neoplasia, Wilm's tumor, Ewing's sarcoma, and malignant hydatidiform mole. toxicity: BM suppression, fatigue, hair loss, diarrhea, mouth ulcer, and loss of appetite. what is the drug?

Answer 32

dactinomycin dactinomycin is an antibiotic. it inhibits transcription. it binds DNA at the transcription initiation complex and preventing elongation of RNA chain by RNAP. it's used in combination w/ vincristine and cyclophosphamide to treat rhabdomyosarcoma. dactinomycin is used to treat rhabdomyosarcoma, gestational trophoblastic neoplasia, Wilm's tumor, Ewing's sarcoma, and malignant hydatidiform mole. dactinomycin causes BM suppression, fatigue, hair loss, diarrhea, mouth ulcer, and loss of appetite.

Question 33

MOA: it's a nitrate. it vasodilates via release of nitirc oxide. the major effect is preload reduction (veins dilate, blood pools in veins, and venous return (VR) to the heart decreases), resulting in decreased O₂ demand. may cause some afterload reduction also. uses: treats stable angina, unstable angina, and prinzmetal angina route of admin.: sublingual toxicity: tachycardia, orthostatic hypotension, and headache what is the drug?

Answer 33

nitroglycerine nitroglycerine is a nitrate nitroglycerine vasodilates via release of nitirc oxide. the major effect is preload reduction (veins dilate, blood pools in veins, and venous return (VR) to the heart decreases), resulting in decreased O2 demand. may cause some afterload reduction also. nitroglycerine is administered sublingually and is used to treat stable angina, unstable angina, and prinzmetal angina nitroglycerine causes tachycardia, orthostatic hypotension, and headache

Question 34

MOA: it's a nitrate. it vasodiates via release of nitirc oxide. the major effect is preload reduction (veins dilate, blood pools in veins, and venous return (VR) to the heart decreases), resulting in decreased O2 demand. may cause some afterload reduction also. uses: treats stable angina, unstable angina, and prinzmetal angina route of admin.: oral toxicity: tachycardia, orthostatic hypotension, and headache what is the drug?

Answer 34

isosorbide dinitrate isosorbide dinitrate vasodiates via release of nitirc oxide. the major effect is preload reduction (veins dilate, blood pools in veins, and venous return (VR) to the heart decreases), resulting in decreased O2 demand. may cause some afterload reduction also. isosorbide dinitrate is used to treat stable angina, unstable angina, and prinzmetal angina. isosorbide dinitrate is administered orally. isosorbide dinitrate causes tachycardia, orthostatic hypotension, and headache.

Question 35

MOA: it's a nonselective ß-blocker. it blocks ß1 and ß2 receptors. it reduces O₂ demand by reducing HR and cardiac contractility by blocking ß1 effects. it's a negative chronotrope (it decr. HR) it's a negative inotrope (it decr. cardiac contractility). it also inhibits renin production by blocking ß1 effects. it acts on ß1 receptors on the heart and kidney and ß2 receptors on arterioles. use: it's used to treat stable angina and unstable angina, but NOT prinzmetal's angina. toxicity: bradycardia and AV block what is the drug?

Answer 35

propanolol propanolol is a nonselective ß-blocker. it blocks ß1 and ß2 receptors. it reduces O2 demand by reducing HR and cardiac contractility by blocking ß1 effects. it's a negative chronotrope (it decr. HR) it's a negative inotrope (it decr. cardiac contractility). it also inhibits renin production by blocking ß1 effects. it acts on ß1 receptors on the heart and kidney and ß2 receptors on arterioles. propanolol is used to treat stable angina and unstable angina, but NOT prinzmetal's angina. propanolol causes bradycardia and AV block