Pharm 5 Cardio pt6 Flashcards Preview

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Flashcards in Pharm 5 Cardio pt6 Deck (13)
1

List the drug interactions of Digitalis (5)

Quinidine
verapamil
beta blockers
Antacids
Thyroid Hormones

2

Drug Interaction of Digitalis + Quinidine or Verapamil. Therefore, whaddya do to prevent it?

addition of quinidine or verapamil elevates digoxin concentration in as little as several hours
Decrease digoxin level by one-half when starting either quinidine or verapamil

3

Drug interaction of Digitalis + beta-blockers

in patients with AV conduction abnormalities: complete heart block

4

Drug interaction of Digitalis + Antacids
Whaddya do to prevent it?

reduce digoxin absorption; take digoxin at least 1 hour before or 4 hours after taking antacids

5

Drug interaction of Digitalis + Thyroid hormones
Whaddya do when starting patients on drugs for thyroid dysfunction?

may decrease therapeutic effectiveness of digoxin
Digoxin dosage adjustment may be necessary when starting patients on drugs for thyroid dysfunction

6

When suspicious of digitalis overdoses. Do what? (3 steps)

1. Stop giving digitalis -duh
2. Tx arrhytmias (hospitalized, monitored setting)
3. Digitalis FAB - antidote for digitalis overdose

7

6 beneficial hemodynamic effects of Digitalis.

Buuuut....

Inc cardiac output
Inc LV Ejection fraction
Dec LV Diastolic Pressure
Inc Exercise tolerance
Inc Natriuresis
Dec Neurohormonal activation
Buuuut: We now know that ppl on Digitalis (with no reason for mortality) have a dramatically higher mortality. It kills people

8

42-year old African-American male with new onset hypertension without any co-morbidity.
Whaddya use? Why?
What if they fail?

Diuretic
If they fail: Change to or add a CCB
Diuretics work especially well in African Americans.
Some data says CCB works slightly better in African Americans.

9

38-year old Caucasian male, well-controlled IDDM (insulin-dependent)
Whaddya use? Why?

ACE
(ACE or ARB: b/c of renal protection)

10

52-year old African American male one-week s/p AMI
Whaddya use?

Beta-blocker and, possibly, an ACE

11

65-year old Caucasian male with BPH
Whaddya use?

Alpha-adrenergic receptor antagonist

12

71-year old female with isolated systolic hypertension
Whaddya use?

Long-acting CCB

13

39-year old with prior episodes of PSVT (Paroxysmal supraventricular tachycardia)

Beta blocker OR CCB