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Flashcards in Pharm Table Deck (105)
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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
Q

In what syndrome are Class II anti-arrhythmics contraindicated?

A

WPW - Wolff-Parkinson-White (WPW) syndrome, an extra electrical pathway between your heart’s upper chambers (atria) and lower chambers (ventricles)

26
Q

Class II anti-arrhythmics are known for what major therapeutic effect?

A

Decreases mortality in CHF
Metoprolol, acebutolol, esmolol;
Propanolol, carvedilol.

27
Q

Class: Propanolol, carvedilol.

A

Class II anti-arrhythmics - beta blockers (non-selective)

28
Q

MOA: Propanolol, carvedilol.

A

Blocks beta-adrenergic receptors; decrease SA, AV node activity (phase 4 depolarization)

29
Q

Use: Propanolol, carvedilol.

A

Control of ventricular rate in atrial fibrillation/flutter;
long-term suppression of SVTs;
PVCs

30
Q

Side Effects: Propanolol, carvedilol.

A

Heart block;
hypotension,
brochospasm;
bradycardia

31
Q

Class: Flecainide, propafenone, moricizine

A

Class IC anti-arrhythmics

32
Q

MOA: Flecainide, propafenone, moricizine

A

Sodium channel blockers (most potent in class I), acting as negative ionotrope

33
Q

Use: Flecainide, propafenone, moricizine

A

Atrial fibrillation/flutter,
paroxsymal supraventricular tachycardia,
ventricular tachycardia

34
Q

Side Effects: Flecainide, propafenone, moricizine

A

Worsened heart failure, proarrhythmia in ischemic tissue, increased mortality

35
Q

Class: Lidocaine, mexiletine

A

Class IB anti-arrhythmics

36
Q

MOA: Lidocaine, mexiletine

A

Block sodium channels in inactivated state mostly;

no action on atrial tissue

37
Q

Use: Lidocaine, mexiletine

A

Digitalis toxicity

38
Q

Side Effect: Lidocaine, mexiletine

A

Tremor; nausea; seizures; local anesthetic action

39
Q

Mexiletine is a Class IB anti-arrythmic known for what side effect?

A

GI toxicity

40
Q

Class: Quinidine, procainamide, disopyramide

A

Class IA anti-arrhythmics

41
Q

MOA: Quinidine, procainamide, disopyramide

A

Class IA anti-arrhythmics
Block inward potassium rectifying channel (slow rate) at normal concentrations;
blocks sodium channels (fast rate) at high concentrations

42
Q

Use: Quinidine, procainamide, disopyramide

A

Atrial fibrillation/flutter,
paroxsymal supraventricular tachycardia,
ventricular tachycardia

43
Q

Side Effect: Quinidine, procainamide, disopyramide

A

QT prolongation; TdP arrhythmias; heart block; hypotension; lupus-like syndrome

44
Q

What side effect is flecainide known for?

A

Blurred vision w/ flecainide

45
Q

What side effect is propafenone known for?

A

sinus bradycardia & brochospasm

46
Q

What drug is an Alternative to amiodarone for shock-refractory cardiac arrest?

A

Magnesium sulfate

anti-arrhythmic

47
Q

What specific side effects does quinidine (Class IA anti-arrhythmics) have?

A

GI symptoms; cinchonism, hepatitis, & thrombocytopenia w/ quinidine

48
Q

What specific side effects does disopyramide have (Class IA anti-arrhythmic)

A

anticholinergic effects

49
Q

Class: Ezetimbe (Zetia)

A

Inhibits enterocyte absorption of cholesterol in intestine

50
Q

MOA: Ezetimbe (Zetia)

A

Inhibits enterocyte absorption of cholesterol in intestine;

Decreases LDL-C alone (15-20%) or in combination w/statin (60%)

51
Q

Use: Ezetimbe (Zetia)

A

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
Q

Class: Bisoprolol (Zebeta); Nadolol (Corgard)

A

Beta-1 selective blocker

53
Q

Class: Pravastatin; Fluvastatin

A

HMG-CoA reductase Inhibitors (statins)

54
Q

MOA: Pravastatin; Fluvastatin

A

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
Q

Use: Pravastatin; Fluvastatin

A

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
Q

Side Effects: Pravastatin; Fluvastatin

A

Very few; hepatic dysfunction in 1% (serious hepatotoxicity rare); myopathy/rhabdomyolysis (reduced if factors inhibiting statin catabolism lacking)

57
Q

What is special about the administration of Pravastatin; Fluvastatin (HMG-CoA reductase Inhibitors (statins))?

A

Must be taken in the evening

58
Q

Class: Lovastatin, Simvastatin

A

HMG-CoA reductase Inhibitors (statins)

59
Q

What is special about lovastatin and simvastatin?

A

Both have a lactone prodrug

60
Q

Class: Atorvastatin; Rosuvastatin; Pitavastatin

A

HMG-CoA reductase Inhibitors (statins)

61
Q

MOA: Atorvastatin; Rosuvastatin; Pitavastatin

A

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
Q

Use: Atorvastatin; Rosuvastatin; Pitavastatin

A
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
Q

Side Effects: Atorvastatin; Rosuvastatin; Pitavastatin

A

Very few; hepatic dysfunction in 1% (serious hepatotoxicity rare); myopathy/rhabdomyolysis (reduced if factors inhibiting statin catabolism lacking)

64
Q

What is unique about Atorvastatin; Rosuvastatin; Pitavastatin as statins?

A

Longer half life than other statins, can be taken anytime during the day

65
Q

Class: Niacin

A

Nicotinic acid

66
Q

MOA: Niacin

A

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
Q

Use: Niacin

A

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
Q

Side Effects: Niacin

A

Flushing, pruritis of face and upper trunk, rashes, acanthosis nigricans (hyperpigmentation)

69
Q

Niacin is contraindicated in what patient population?

A

DM and gout

Water soluble B vitamin complex at [low]; hypolipidemic at [high]; side effects limit compliance (

70
Q

Class:
Clofibrate
Gemfibrozil
Fenofibrate

A

Fibric Acid Derivatives (Fibrates)

71
Q

Use:
Clofibrate
Gemfibrozil
Fenofibrate

A

Marked reduction in VLDL (thus, triglycerides);
variable and small effect on LDL;
small increase in HDL (10%);
severe hypertriglyceridemia

72
Q

Should fibric acid derivatives (Clofibrate, Gemfibrozil, Fenofibratebe) used with statins?

A

Combination w/ statin inadvisable due to higher myositis risk

73
Q

Class: Dobutamine

A

Inotrope
β1 receptor agonist
Positive inotrope and chronotrope

74
Q

Use: Milrinone

A

Acute setting of heart failure; short-term only

75
Q

Class:

Milrinone

A

Inotrope

76
Q

Use: Dobutamine

A

Use in Acutely decompensated patients (about half will die after 6 months)

77
Q

Side Effects: Milrinone

A

Increased hypotensive and atrial arrhythmia events acutely. 2 month mortality nearly 50% higher than placebo

78
Q

MOA: Milrinone

A

Phosphodiesterase IIIa inhibitor

79
Q

Class: Carvedilol

A
combined alpha-beta blocker AND
class II anti-arrythmic
80
Q

MOA: Carvedilol

A

Beta 1 blockade with vasodilatory effects

combined ab blocker

81
Q

Use: Carvedilol

A

Acute coronary syndrome
CHF;
long-term suppression of SVTs

82
Q

Class: Labetolol

A

combined ab blocker

83
Q

MOA: Labetolol

A

Beta 1 blockade with vasodilatory effects

combined ab blocker

84
Q

Use: Labetolol

A

Hypertensive urgency (emergency?)

85
Q

Class: Enalapril

A

ACE inhibitor (vasodilator)

86
Q

MOA: Enalapril

A

Blocks angiotensin I –> angiotensin II;

prevents breakdown of bradykinin

87
Q

What is the effect of angiotensin II on the vasculature?

A

Angiotensin II is a potent vasoconstrictor

88
Q

Use: Enalapril

A

CHF;
LV hypertrophy;
post-MI, prevents LV remodeling

89
Q

Side Effects: Enalapril and other ACE inhibitors

A

dry cough;
angioedema;
decreased renal fx;
hypotension

90
Q

What other uses does Nifedipine have besides SVT tx?

A

Raynaud’s;

Angine (3rd choice drug)

91
Q

Use: Doxazosin

A

BPH

alpha-1 adrenergic antagonist

92
Q

T/F: Beta-blockers, loop diuretics and thiazide diuretics may all raise serum lipids.

A

True

ACE inhibitors have not been demonstrated to effect serum lipid levels.

93
Q

What is the effect of alpha-1 adrenergic receptors on serum lipids?

A

Alpha-1-adrenergic receptor antagonists have a neutral or beneficial effect on serum lipids.

94
Q

T/F: Thiazide -type diuretics tend to increase serum Ca2+ levels and may slow demineralization in osteoporosis.

A

True

95
Q

Can ACE-Is and ARBs be used in pregnancy?

A

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
Q

What is the drug of choice for patients with DM and kidney disease?

A
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
Q

Class: Dipyridamole

A

Pyrimido-pyramidine antiplatelet agent

98
Q

Use: Dipyridamole

A

stress testing of heart;

angina

99
Q

Use: Ticlopidine

A

Ticlopidine is a thienopyridine antiplatelet agent used as an aspiring alternative in the treatment of angina

100
Q

Verapamil and diltiazem are non-dihydropyridine calcium channel blockers that have what effect?

A

Vasodilation

use in HTN, SVT, as an anti-anginal

101
Q

How does Ezetimibe lower cholesterol?

A

Ezetimibe is a new lipid-lowering drug that inhibits a sterol transporter that moves cholesterol into the wall of the small intestine

102
Q

The fibrates are a class of hypolipidemic drugs that have several effects on lipid metabolism, all of which are initiated by the activation of:

A

PPARα, a nuclear receptor expressed in skeletal muscle, cardiac muscle, hepatocytes, and macrophages.

103
Q

the combination of a fibrate with a statin that is inadvisable due to:

A

a significantly increased risk of myositis

104
Q

Bile acid sequestrants (Colestipol, Cholestyramine, Colesevelam) are also known as;

A

Resins

can increase serum TG levels

  • *the only hypolipidemic indicated for use in children**
  • *standard tx in combination with statins
105
Q

Bila acid sequestrants are contraindicated for patients with what condition?

A

Hypertriglyceridemia