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S.N Pharmacology I > 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 36-40 h: requires loading dose
Renal elimination
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16
Q

Digoxin displacement by which other drugs?

A

Verapamil
Quinidine
Amiodarone

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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
Xanthopsia
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
WPW
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 Frequent depol: More inhibited Blocks K+ ch so prolonged repol. Procainamide Disopyramide Quinidine
36
Class Ib MOA and names
Blocks inactivated Na ch. Preferance for tissues partly depol. Increased threshold for excitation Lidocaine Mexiletine
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. Especially His-Purkinje tissue No ANS effects Propafenone
40
Propafenone is given
Oraly
41
Class II AA
Esmolol (Acebutalol) (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 Ibutilide Dofetilide 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 ```

S.N Pharmacology I (15 decks)

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