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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
Dobutamine indications
Acute HF: Systolic function ↑
26
PDE inhibitor for the management of AHF?
Milrinonr
27
Milrinone MOA
↑ cAMP in heart muscle: Positive ionotropic (Contractility) | ↑ cAMP in vascular smooth muscle: TPR ↓
28
How to give Milrinone?
IV
29
Milrinonr indication and contra
AHF Contra. in chronic management
30
Levosimenadan MOA
Ca2+ sensitizing agent Positive ionotropic Inhibits PDE (Vasodilation) Open ATP-sensitive K ch (Vasodilation)
31
Ca2+ sensitizing agent
Levosimenadan
32
Levosimenadan indications
Acute decompensated HF`
33
Levosimenadan contra.
Hypotension
34
What each class I AA do to the Action potential?
Ia: Prolonged AP Ib: Shorten AP Ic: No effect
35
Class Ia MOA and names
- Blocks open/inactive FAST Na+ ch - for Frequent depol tissue - Blocks K+ ch so prolonged repol. Procainamide Quinidine
36
Class Ib MOA and names
- Blocks inactivated Na ch. - partly depol. tissue - Increased threshold for excitation Lidocaine
37
Lidocaine indications
Ventricular arrhythmias Open heart surgery Digoxin toxicity
38
Lidocaine side effects
Seizures | Least cardiotoxic!
39
Class Ic MOA and names
- Block fast Na ch. - His-Purkinje tissue - No ANS effects Propafenone
40
Propafenone is given
Oraly
41
Class II AA
Esmolol | Propranolol
42
Esmolol AA indications
Intraoperative | Acute arrhythmias
43
Class III AA MOA
K+ ch. blockrs Slows down phase 2 and 3 Rhythm control
44
Class III AA drugs
Amiodarone | Sotalol
45
Amiodarone drug properties
``` 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
Amiodarone side effects
``` Thyroid abnormalities Skin and cornea deposition Pulmonary fibrosis Photosensitivity Hepatic toxicity Heart block Neurotoxicity ```
47
Sotalol MOA
Blocks K+ ch. | Non selective B blocker
48
Sotalol | How to give? Duration?
Oral | 7 h
49
Sotalol indications
Ventricular arrhythmias A.Fib (May cause Dose dependent TdP)
50
Class IV AA MOA
Blocks L type Ca2+ ch.
51
Class IV AA drugs | How to give?
Verapamil | Oral, last 5-7 h
52
Verapamil indications
AV nodal arrhythmias
53
Verapamil side effects
``` Constipation Dizziness Flushing Hypotension AV block Gingival hypertrophy ```
54
Class V AA drugs
Adenosine Mg2+ Digoxin
55
Adenosine R and their G protein
A1-R-Gi: K+ current ↑, Ca2+ current ↓, hyperopolariz. | A2-R-Gs: Vasodilation
56
Adenosine | How to give? Duration?
IV | 10-15 min
57
Adenosine indications
AV arrhythmias | Paroxysmal SVT
58
Adenosine side effects
``` Flushing Sedation Dyspnea Hypotension Chest pain Sense of impending down ```
59
Adenosine can be antagonized with
Theophylline
60
Mg++ as an AA
Intracts with Na/K ATPase and CA ch.
61
Mg++ is given how
IV
62
Mg++ indications
TdP Long QT syndrome Digitalis induces arrhythmias
63
Digoxin as an AA
Inhibition of neuronal Na/K ATPase → Vagal tone ↑ → negative chronotropic AV conduction ↓ → negative dromotropic
64
Rate control. Which AA will we choose? Indications?
Class II and IV Age > 65 Hypertension AF
65
Rhytm control. Which AA will we choose? Indications?
``` Class I and III Age < 65 More symptomatic No hypertension New AF ```

phrm (11 decks)

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