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phrm > B: 14-16 > Flashcards

B: 14-16 Flashcards

1
Q

Pharmacotheraputic aims of Manangement of HF

A

↓ Preload
↓ Afterload
↓ Cardiac muscle remodeling
↑ Contractility (Ionotropic)

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2
Q

What is Preload?

A

Volume of blood in the ventricles at the end of diastole

Stretch

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3
Q

What is Afterload?

A

Resistance left ventricle must ovrcome to pump blood

Squeeze

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4
Q

Which drugs can help lower preload?

A

Diuretics
ACEI
ARB’s
Venodilators

Less blood in the heart system

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5
Q

Which drugs can help lower afterload?

A

ACEI
ARB’s
Arteriodilators

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6
Q

Which drugs can help increase contractility?

A

Digoxin
B agonists
PDE-III inhibitors

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7
Q

Which drugs can help lower cardiac muscle remodeling?

A

ACEI
ARB’s
Spironolactone
B blockers

Help improve survival!

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8
Q

Digoxin is for Acute/chronic management of HF?

A

Chronic

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9
Q

Which diuretics are given in case of HF?

A

Thiazides: Hydrochlorothiazides
Loop diuretics: Furosemide
K+ sparing agents: Spironolactone

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10
Q

ACE inhibitors which are given in case of HF?

A

Captopril
Enalapril
Perindopril

אפריל מהאופיס קצת דומה לאייס

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11
Q

ARB’s which are given in case of HF?

A

Losartan
Valsartan
Irbesartan

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12
Q

B blockers which are given in case of HF?

A

Metoprolol (B1 selective antag.)

Carvedilol (B and a)

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13
Q

Positive iontropic agents

A

Cardiac glycosides: Digoxin, Digitoxin

Sympathomimetics: Dobutamine

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14
Q

Cardiac glycosides MOA

A

Inibition of cadiac Na/K ATPase → Na/Ca exchanger wont work as well → I.C Ca2+ conc. ↑ → Increased actin-myosin interaction → positive ionotropic
Inhibition of neuronal Na/K ATPase → vagal activity ↑ → Negative chronotropic
AV conduction ↓ → Negative dromotropic

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15
Q

Digoxin drug properties

A 
Oral: bioavailability 75%
Narroe theraputic index
Onset of action 0.5-1 h
Elimination half life 30-40 h: requires loading dose
Renal elimination
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16
Q

Digoxin displacement by which other drugs?

A

Quinidine
Amiodarone
Verapamil

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17
Q

Digoxin indications

A

CHF

Arrhythmias: SVT, A.Fib, A.Flutter

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18
Q

Digoxin adverse effects

A 
Hyperkalemia
GI
ECG changes
Conduction blocks
Arrhythmias
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19
Q

Predisposing factors for Digoxin toxicity

A

Renal impairment
Hypokalemia
Hypomangesemia
Hypercalcemia

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20
Q

Treatment for Digoxin toxicity

A

Correcting electrolyted
Class Ib: Lidocaine, Phenytoin
Ab

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21
Q

Digoxin contraindications

A

Hypertrophic cardiomyopathy
AV block
Diastolic HF

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22
Q

Digitoxin drug properties

A

Oral: bioavailability 90%
Onset of action 3-6 h
Elimination half life 5-7 h: requires loading dose
Hepatic metabolism

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23
Q

Digitoxin indications

A

CHF

Arrhythmias: SVT, A.Fib, A.Flutter

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24
Q

Dobutamin

Tell me about it

A

B1 selective
Parenteral
Duration is minutes

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25
Q

Dobutamine indications

A

Acute HF: Systolic function ↑

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26
Q

PDE inhibitor for the management of AHF?

A

Milrinonr

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27
Q

Milrinone MOA

A

↑ cAMP in heart muscle: Positive ionotropic (Contractility)

↑ cAMP in vascular smooth muscle: TPR ↓

28
Q

How to give Milrinone?

A

IV

29
Q

Milrinonr indication and contra

A

AHF

Contra. in chronic management

30
Q

Levosimenadan MOA

A

Ca2+ sensitizing agent
Positive ionotropic
Inhibits PDE (Vasodilation)
Open ATP-sensitive K ch (Vasodilation)

31
Q

Ca2+ sensitizing agent

A

Levosimenadan

32
Q

Levosimenadan indications

A

Acute decompensated HF`

33
Q

Levosimenadan contra.

A

Hypotension

34
Q

What each class I AA do to the Action potential?

A

Ia: Prolonged AP
Ib: Shorten AP
Ic: No effect

35
Q

Class Ia MOA and names

A
  • Blocks open/inactive FAST Na+ ch
  • for Frequent depol tissue
  • Blocks K+ ch so prolonged repol.

Procainamide
Quinidine

36
Q

Class Ib MOA and names

A
  • Blocks inactivated Na ch.
  • partly depol. tissue
  • Increased threshold for excitation

Lidocaine

37
Q

Lidocaine indications

A

Ventricular arrhythmias
Open heart surgery
Digoxin toxicity

38
Q

Lidocaine side effects

A

Seizures

Least cardiotoxic!

39
Q

Class Ic MOA and names

A
  • Block fast Na ch.
  • His-Purkinje tissue
  • No ANS effects

Propafenone

40
Q

Propafenone is given

A

Oraly

41
Q

Class II AA

A

Esmolol

Propranolol

42
Q

Esmolol AA indications

A

Intraoperative

Acute arrhythmias

43
Q

Class III AA MOA

A

K+ ch. blockrs
Slows down phase 2 and 3
Rhythm control

44
Q

Class III AA drugs

A

Amiodarone

Sotalol

45
Q

Amiodarone drug properties

A 
Blocks Na, K, Ca, B-adrenoreceptor
HR ↓
AV node conduction ↓
Elimination half life 1-10 weeks
Binds to tissues
Inhibits CYP450 (Careful with Warfarin, Statins)
46
Q

Amiodarone side effects

A 
Thyroid abnormalities
Skin and cornea deposition
Pulmonary fibrosis
Photosensitivity
Hepatic toxicity
Heart block
Neurotoxicity
47
Q

Sotalol MOA

A

Blocks K+ ch.

Non selective B blocker

48
Q

Sotalol

How to give? Duration?

A

Oral

7 h

49
Q

Sotalol indications

A

Ventricular arrhythmias
A.Fib

(May cause Dose dependent TdP)

50
Q

Class IV AA MOA

A

Blocks L type Ca2+ ch.

51
Q

Class IV AA drugs

How to give?

A

Verapamil

Oral, last 5-7 h

52
Q

Verapamil indications

A

AV nodal arrhythmias

53
Q

Verapamil side effects

A 
Constipation
Dizziness
Flushing
Hypotension
AV block
Gingival hypertrophy
54
Q

Class V AA drugs

A

Adenosine
Mg2+
Digoxin

55
Q

Adenosine R and their G protein

A

A1-R-Gi: K+ current ↑, Ca2+ current ↓, hyperopolariz.

A2-R-Gs: Vasodilation

56
Q

Adenosine

How to give? Duration?

A

IV

10-15 min

57
Q

Adenosine indications

A

AV arrhythmias

Paroxysmal SVT

58
Q

Adenosine side effects

A 
Flushing
Sedation
Dyspnea
Hypotension
Chest pain
Sense of impending down
59
Q

Adenosine can be antagonized with

A

Theophylline

60
Q

Mg++ as an AA

A

Intracts with Na/K ATPase and CA ch.

61
Q

Mg++ is given how

A

IV

62
Q

Mg++ indications

A

TdP
Long QT syndrome
Digitalis induces arrhythmias

63
Q

Digoxin as an AA

A

Inhibition of neuronal Na/K ATPase → Vagal tone ↑ → negative chronotropic
AV conduction ↓ → negative dromotropic

64
Q

Rate control. Which AA will we choose? Indications?

A

Class II and IV
Age > 65
Hypertension
AF

65
Q

Rhytm control. Which AA will we choose? Indications?

A 
Class I and III
Age < 65
More symptomatic
No hypertension
New AF

phrm (11 decks)

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