Pharm Table Flashcards
(105 cards)
1
Q
Class: Magnesium sulfate
A
Anti-arrhythmic
2
Q
Class: Digoxin
A
Anti-arrhythmic
3
Q
Class: Adenosine
A
Anti-arrhythmic
4
Q
MOA: Digoxin
A
Na/K pump inhibitor, slow AVN activity and conduction
5
Q
MOA: Adenosine
A
Adenosine receptors in atrium, sinus node, AV node; activates K current shortening AP, automaticity and AV conduction
6
Q
Use: Magnesium sulfate
A
Prevents recurrent TdP and some digitalis-induced arrhythmia
7
Q
Use: Digoxin
A
Atrial fibrillation,
chronic SVT (Supraventricular Tachycardia),
HF
8
Q
Use: Adenosine
A
AF,
paroxysmal Supraventricular Tachycardia
9
Q
Side Effects: Digoxin
A
Nausea, cognitive dysfunction, blurred or yellow vision
10
Q
Side Effects: Adenosine
A
Sedation, dyspnea, hypotension
11
Q
Class: Nifedipine, amlodipine, verapamil, diltiazam
A
Class IV anti-arrhythmics - calcium chanel blockers
12
Q
MOA: Nifedipine, amlodipine, verapamil, diltiazam
A
Class IV anti-arrhythmics - calcium chanel blockers
Blockade of L-type calcium channels: slow SA & AV node activity;
prolong AV refractoriness
13
Q
Use: Nifedipine, amlodipine, verapamil, diltiazam
A
Prevent or terminate reentrant SVTs
14
Q
In what syndrome are calcium channel blockers (Nifedipine, amlodipine, verapamil, diltiazam) contraindicated?
A
WPW - Wolff-Parkinson-White (WPW) syndrome, an extra electrical pathway between your heart’s upper chambers (atria) and lower chambers (ventricles)
15
Q
Digoxin is an anti-arrythmic known for its:
A
low therapeutic index
16
Q
Class: Sotalol, amiodarone, dofetilide, ibutelide, dronedarone
A
Class III anti-arrhythmics
17
Q
MOA: Sotalol, amiodarone, dofetilide, ibutelide, dronedarone
A
Class III anti-arrhythmics
K channel blockade = prolongs refractoriness
18
Q
Use: Sotalol, amiodarone, dofetilide, ibutelide, dronedarone
A
Atrial fibrillation/flutter,
paroxsymal supraventricular tachycardia,
ventricular tachycardia
19
Q
Side Effects: Sotalol, amiodarone, dofetilide, ibutelide, dronedarone
A
Torsades de Pointes; QT prolongation, bradycardia; pulmonary fibrosis, peripheral neuropathy, hepatic dysfunction, hypotension, bronchospasm
20
Q
Blue-gray skin is a known side effect of what drugs?
A
Class III anti-arrhythmics - Sotalol, AMIODARONE, dofetilide, ibutelide, dronedarone
Photosensitivity (blue-gray skin; numerous drug interactions; N & V w/ dronedarone
21
Q
Class: Metoprolol, acebutolol, esmolol
A
Class II anti-arrhythmics AND beta blockers (selective)
22
Q
MOA: Metoprolol, acebutolol, esmolol
A
Class II anti-arrhythmics -
beta blockers (selective)
Blocks beta-adrenergic receptors; decrease SA, AV node activity (phase 4 depolarization)
23
Q
Use: Metoprolol, acebutolol, esmolol
A
Control of ventricular rate in atrial fibrillation/flutter;
long-term suppression of SVTs; PVCs
24
Q
Side Effects: Metoprolol, acebutolol, esmolol
A
Heart block; hypotension, brochospasm; bradycardia
25
In what syndrome are Class II anti-arrhythmics contraindicated?
WPW - Wolff-Parkinson-White (WPW) syndrome, an extra electrical pathway between your heart's upper chambers (atria) and lower chambers (ventricles)
26
Class II anti-arrhythmics are known for what major therapeutic effect?
Decreases mortality in CHF
Metoprolol, acebutolol, esmolol;
Propanolol, carvedilol.
27
Class: Propanolol, carvedilol.
Class II anti-arrhythmics - beta blockers (non-selective)
28
MOA: Propanolol, carvedilol.
Blocks beta-adrenergic receptors; decrease SA, AV node activity (phase 4 depolarization)
29
Use: Propanolol, carvedilol.
Control of ventricular rate in atrial fibrillation/flutter;
long-term suppression of SVTs;
PVCs
30
Side Effects: Propanolol, carvedilol.
Heart block;
hypotension,
brochospasm;
bradycardia
31
Class: Flecainide, propafenone, moricizine
Class IC anti-arrhythmics
32
MOA: Flecainide, propafenone, moricizine
Sodium channel blockers (most potent in class I), acting as negative ionotrope
33
Use: Flecainide, propafenone, moricizine
Atrial fibrillation/flutter,
paroxsymal supraventricular tachycardia,
ventricular tachycardia
34
Side Effects: Flecainide, propafenone, moricizine
Worsened heart failure, proarrhythmia in ischemic tissue, increased mortality
35
Class: Lidocaine, mexiletine
Class IB anti-arrhythmics
36
MOA: Lidocaine, mexiletine
Block sodium channels in inactivated state mostly;
| no action on atrial tissue
37
Use: Lidocaine, mexiletine
Digitalis toxicity
38
Side Effect: Lidocaine, mexiletine
Tremor; nausea; seizures; local anesthetic action
39
Mexiletine is a Class IB anti-arrythmic known for what side effect?
GI toxicity
40
Class: Quinidine, procainamide, disopyramide
Class IA anti-arrhythmics
41
MOA: Quinidine, procainamide, disopyramide
Class IA anti-arrhythmics
Block inward potassium rectifying channel (slow rate) at normal concentrations;
blocks sodium channels (fast rate) at high concentrations
42
Use: Quinidine, procainamide, disopyramide
Atrial fibrillation/flutter,
paroxsymal supraventricular tachycardia,
ventricular tachycardia
43
Side Effect: Quinidine, procainamide, disopyramide
QT prolongation; TdP arrhythmias; heart block; hypotension; lupus-like syndrome
44
What side effect is flecainide known for?
Blurred vision w/ flecainide
45
What side effect is propafenone known for?
sinus bradycardia & brochospasm
46
What drug is an Alternative to amiodarone for shock-refractory cardiac arrest?
Magnesium sulfate
| anti-arrhythmic
47
What specific side effects does quinidine (Class IA anti-arrhythmics) have?
GI symptoms; cinchonism, hepatitis, & thrombocytopenia w/ quinidine
48
What specific side effects does disopyramide have (Class IA anti-arrhythmic)
anticholinergic effects
49
Class: Ezetimbe (Zetia)
Inhibits enterocyte absorption of cholesterol in intestine
50
MOA: Ezetimbe (Zetia)
Inhibits enterocyte absorption of cholesterol in intestine;
| Decreases LDL-C alone (15-20%) or in combination w/statin (60%)
51
Use: Ezetimbe (Zetia)
Inhibits cholesterol absorption by enterocytes in jejunum (70% in mice), leading to less cholesterol in chylomicrons; reduction in chylomicron remnant cholesterol delivery to liver; may also decrease atherogenesis directly (remnants very atherogenic)
52
Class: Bisoprolol (Zebeta); Nadolol (Corgard)
Beta-1 selective blocker
53
Class: Pravastatin; Fluvastatin
HMG-CoA reductase Inhibitors (statins)
54
MOA: Pravastatin; Fluvastatin
Inhibits HMG-CoA reductase formation of mevalonate; leads to activation of SREBP, a membrane-bound transcription factor that increases LDL-R synthesis and lessens degradation; reduction in cholesterol decreases VLDL synthesis, lowering TG
55
Use: Pravastatin; Fluvastatin
Reduce LDL (20-55%) and TG (25%), while increasing HDL (5-10%);
treatment of dyslipidemia (reduces fatal & nonfatal CHD, strokes;
total mortality reduction is 20%)
56
Side Effects: Pravastatin; Fluvastatin
Very few; hepatic dysfunction in 1% (serious hepatotoxicity rare); myopathy/rhabdomyolysis (reduced if factors inhibiting statin catabolism lacking)
57
What is special about the administration of Pravastatin; Fluvastatin (HMG-CoA reductase Inhibitors (statins))?
Must be taken in the evening
58
Class: Lovastatin, Simvastatin
HMG-CoA reductase Inhibitors (statins)
59
What is special about lovastatin and simvastatin?
Both have a lactone prodrug
60
Class: Atorvastatin; Rosuvastatin; Pitavastatin
HMG-CoA reductase Inhibitors (statins)
61
MOA: Atorvastatin; Rosuvastatin; Pitavastatin
Inhibits HMG-CoA reductase formation of mevalonate; leads to activation of SREBP, a membrane-bound transcription factor that increases LDL-R synthesis and lessens degradation; reduction in cholesterol decreases VLDL synthesis, lowering TG
62
Use: Atorvastatin; Rosuvastatin; Pitavastatin
```
Reduce LDL (20-55%) and TG (25%), while increasing HDL (5-10%);
treatment of dyslipidemia (reduces fatal & nonfatal CHD, strokes; total mortality reduction is 20%)
```
63
Side Effects: Atorvastatin; Rosuvastatin; Pitavastatin
Very few; hepatic dysfunction in 1% (serious hepatotoxicity rare); myopathy/rhabdomyolysis (reduced if factors inhibiting statin catabolism lacking)
64
What is unique about Atorvastatin; Rosuvastatin; Pitavastatin as statins?
Longer half life than other statins, can be taken anytime during the day
65
Class: Niacin
Nicotinic acid
66
MOA: Niacin
Reduction of liver triglyceride synthesis, leading to less hepatic VLDL (thus, LDL) production;
decreases lipolysis in adipose tissue, leading to lowered FFA transport to liver (thus, less triglycerides);
reduced hepatic clearance of ApoAI (raising HDL)
67
Use: Niacin
Best agent to increase HDL (30-40%);
as good as fibrates and statins at lowering triglycerides (35-45%); lowers LDL (20-30%);
hypertriglyceridemia and low HDL
68
Side Effects: Niacin
Flushing, pruritis of face and upper trunk, rashes, acanthosis nigricans (hyperpigmentation)
69
Niacin is contraindicated in what patient population?
DM and gout
| Water soluble B vitamin complex at [low]; hypolipidemic at [high]; side effects limit compliance (
70
Class:
Clofibrate
Gemfibrozil
Fenofibrate
Fibric Acid Derivatives (Fibrates)
71
Use:
Clofibrate
Gemfibrozil
Fenofibrate
Marked reduction in VLDL (thus, triglycerides);
variable and small effect on LDL;
small increase in HDL (10%);
severe hypertriglyceridemia
72
Should fibric acid derivatives (Clofibrate, Gemfibrozil, Fenofibratebe) used with statins?
Combination w/ statin inadvisable due to higher myositis risk
73
Class: Dobutamine
Inotrope
β1 receptor agonist
Positive inotrope and chronotrope
74
Use: Milrinone
Acute setting of heart failure; short-term only
75
Class:
| Milrinone
Inotrope
76
Use: Dobutamine
Use in Acutely decompensated patients (about half will die after 6 months)
77
Side Effects: Milrinone
Increased hypotensive and atrial arrhythmia events acutely. 2 month mortality nearly 50% higher than placebo
78
MOA: Milrinone
Phosphodiesterase IIIa inhibitor
79
Class: Carvedilol
```
combined alpha-beta blocker AND
class II anti-arrythmic
```
80
MOA: Carvedilol
Beta 1 blockade with vasodilatory effects
| combined ab blocker
81
Use: Carvedilol
Acute coronary syndrome
CHF;
long-term suppression of SVTs
82
Class: Labetolol
combined ab blocker
83
MOA: Labetolol
Beta 1 blockade with vasodilatory effects
| combined ab blocker
84
Use: Labetolol
Hypertensive urgency (emergency?)
85
Class: Enalapril
ACE inhibitor (vasodilator)
86
MOA: Enalapril
Blocks angiotensin I --> angiotensin II;
| prevents breakdown of bradykinin
87
What is the effect of angiotensin II on the vasculature?
Angiotensin II is a potent vasoconstrictor
88
Use: Enalapril
CHF;
LV hypertrophy;
post-MI, prevents LV remodeling
89
Side Effects: Enalapril and other ACE inhibitors
dry cough;
angioedema;
decreased renal fx;
hypotension
90
What other uses does Nifedipine have besides SVT tx?
Raynaud's;
| Angine (3rd choice drug)
91
Use: Doxazosin
BPH
| alpha-1 adrenergic antagonist
92
T/F: Beta-blockers, loop diuretics and thiazide diuretics may all raise serum lipids.
True
ACE inhibitors have not been demonstrated to effect serum lipid levels.
93
What is the effect of alpha-1 adrenergic receptors on serum lipids?
Alpha-1-adrenergic receptor antagonists have a neutral or beneficial effect on serum lipids.
94
T/F: Thiazide -type diuretics tend to increase serum Ca2+ levels and may slow demineralization in osteoporosis.
True
95
Can ACE-Is and ARBs be used in pregnancy?
No. The use of ACE inhibitors or angiotensin II receptor blockers is contraindicated during pregnancy due to the substantial risk of harm to the fetus.
96
What is the drug of choice for patients with DM and kidney disease?
```
ACE inhibitors (such as lisinopril) are recommended as the drugs of choice in patients with DM and with chronic kidney disease (CKD).
ie Lisinopril
```
97
Class: Dipyridamole
Pyrimido-pyramidine antiplatelet agent
98
Use: Dipyridamole
stress testing of heart;
| angina
99
Use: Ticlopidine
Ticlopidine is a thienopyridine antiplatelet agent used as an aspiring alternative in the treatment of angina
100
Verapamil and diltiazem are non-dihydropyridine calcium channel blockers that have what effect?
Vasodilation
| use in HTN, SVT, as an anti-anginal
101
How does Ezetimibe lower cholesterol?
Ezetimibe is a new lipid-lowering drug that inhibits a sterol transporter that moves cholesterol into the wall of the small intestine
102
The fibrates are a class of hypolipidemic drugs that have several effects on lipid metabolism, all of which are initiated by the activation of:
PPARα, a nuclear receptor expressed in skeletal muscle, cardiac muscle, hepatocytes, and macrophages.
103
the combination of a fibrate with a statin that is inadvisable due to:
a significantly increased risk of myositis
104
Bile acid sequestrants (Colestipol, Cholestyramine, Colesevelam) are also known as;
Resins
can increase serum TG levels
* *the only hypolipidemic indicated for use in children**
* *standard tx in combination with statins
105
Bila acid sequestrants are contraindicated for patients with what condition?
Hypertriglyceridemia
