Cardiac Pharmacology

Question 1

nitrates

Answer 1

action cgmp pathway at smooth mm level

Question 2

ranolozine

Answer 2

increases qt

contraindicated in liver disease

Question 3

clopidogrel pharmacokinetics:

Answer 3

300-600mg loading dose
rapid absorbed- needs 2 oxidation steps
t1/2 8 hr
50% renal 50% gi

Question 4

clopidogrel resistance

Answer 4

cyp 219C
COGENT Study no difference in ppi/clopidigrel pts

alternatives:
prasugrel, ticagrelor (effient, brilanta) 3rd gen P2Y12

Question 5

abciximab

Answer 5

repro

severe thrombocytopenia

Question 6

eptifibatide

Answer 6

integrelin
2b3a inhib
similar to tirofiban

Question 7

thrombolyitics pharm

Answer 7

streptokinase: activates plasminiogen to plasmin-plasmin degrades thrombin and clotting V,Vii, ixx and x- allergy
tpa- selective in fibrin complex rather than systemic

Question 8

antiarrythmics- class 1

Answer 8

block sodium channel

1a: reduce rapid upstroke, prolong AP (quinid, procain, disopyr)
1b: less na block- lidocaine
1c: bind to open channels flecainide, propafenone- do not use in ischemic heart disease

Question 9

quinidine:

Answer 9

class 1a
decreases automaticity, prolong qrs, qt, increase sinus rate
need av nodal blocker first
itp, torsades de pointes

Question 10

procainamide

Answer 10

1a
similar to quinidine- napa levels
ana positive
slow aceteylator may have high levels

Question 11

disopyramide

Answer 11

1a
quinidine like
slow sinus rate
neg inotropic- ppt chf- may use in HOCM
parasymt interaction- urin retention, torsades

Question 12

lidocaine

Answer 12

1b
depresses automaticity, early and late after depolarizations
dose related confusion, paresthesias with liver dz

Question 13

flecainide

Answer 13

1c
depresses rapid upstroke of AP slows conduction
proarrhythmic

Question 14

propafenone

Answer 14

b blocking
1c
similar to flecanide
avoid ischemic use

Question 15

sotalol

Answer 15

d and l isomers- d prolongs repol block k current
l prolongs by b blocker
slows sinus rate, prolongs qt
start in hospital- measure qt

Question 16

amiodarone toxicity

Answer 16

optic neuritis
hypersensitivity pulmonary toxicity- associated with high load doses- resembles pul edema
high dose ster

Question 17

dronedarone

Answer 17

multaq
no iodine- less pul, thyroid
not as effective as amio for afib
cyp3a4 - met pathway- multiple drugs- abx, eryth, clarith, vera, dilt, atorv, grapfruit juice

Question 18

thiazide/ thiazide like

Answer 18

similar action: act on Na/Cl cotransport mechanism- prevents reabsorption of Na in CT
decreases Ca excretion, so may help prevent ca stone
mg, K excreted
metalzone 10x potent hctz

Question 19

chlorthalidone

Answer 19

thiazide like
binds carbonic anhydrase on red cells- continous release with effective t1/2 50-60 hrs
decrease cva, mi etc, superior to hctz
hypokalemia more pronounced-

Question 20

adverse effects of thiazides

Answer 20

lytes
gout
blood dyscrasias
photosenstivity
lithium toxicity, worsens dm, increases ldl and tg

Question 21

ethacrynic acid

Answer 21

loop diuretic without sulfa

Question 22

loop diuretic mechanism of action

Answer 22

bind to Na/Cl pump and prevent reabsorption of Na,K,Cl
4 h2o loss for each pump

Ototoxicity: worse with ethrynic acid- permanent

Question 23

furosemide

Answer 23

poor gut absorption

bumetanide/torsemide 90%absorption

Question 24

sprironlactone

Answer 24

aldosterone antagonist and reduces Na reabsorption

amy interfere with steroid synthesis gyneocomastia

Question 25

diuretic therapy for hypertension in renal insufficiency

Answer 25

thiazides ineffective with gfr <30 | metolazone may work

Question 26

alpha meds for htn

Answer 26

alpha 1receptor blockers alpha 2 receptor agonists presynaptic stimulation decreases output

Question 27

cardioselective b blockers lipid solubility:

Answer 27

lose selectivity at high doses isa may not lower hr as much lipid solubility: lease atenolol, nadolol, less cns effects

Question 28

vasodilating b blockers

Answer 28

labetolol, carvedolol

Question 29

metoprolol succinate

Answer 29

long acting | survival benefit in chf- not shown with tartrate

Question 30

angiotensin CE location

Answer 30

ubiquitous endothelial angiotensin 1 to angotensin 2

Question 31

angiotensin 2 actions

Answer 31

adrenal cortex: increases aldosterone synthesis kidney/gut: sodium h2o absorption CNS: vasopressin, increases sympathetic discharge vascular: vasoconstrictor

Question 32

RAS levels with ace inhibitor

Answer 32

increases: renin renin activity AG1 decreases: AG2, aldo, ace activity

Question 33

aliskiren

Answer 33

tekturna | direct renin inhib, so blocks angiotensinogen to AG1

Question 34

``` different effects on RAS: diuretic acei arb dri ```

Answer 34

diuretic: increases pra, ag1, ag2 acei: increases pra, ag1 and decreases ag2 arb: increases pra, ag1 and ag2 dri: decreases pra, ag1, ag2

Question 35

clonidine

Answer 35

alpha 2 agonist decreases symptathetic outflow- cns effects alpha methyl dopa

Question 36

minoxidil

Answer 36

reflex tachy needs b blocker volume retention pericard effusion

Question 37

statin metabolism

Answer 37

atorvastatin, simvastatin, pravastatin cyp450 3a4 metabolized grapfruit juice, protease, macrolid abx interaction

Question 38

colesevelam

Answer 38

bile acid sequestrant | binds 2 sites

Question 39

fibric acid therapy

Answer 39

``` gemfibrizol may increase inr in warfarin rx decreases TG 30-40% myositis with statin concom use finofibrate not indicated in pregnancy ```

Question 40

digoxin toxicity

Answer 40

not removed with dialysis digibind rx amio will increase levels

Question 41

digoxin action

Answer 41

na/k atpase and decreases function | increases vagal activity

Question 42

milrinone

Answer 42

phosphodiesterase inhibitor- inhibits PDE3 so increases cAMP (cAMP degraded by PDE3 to AMP) increases intracellular Ca and contractility and vasodilates

Question 43

nitroprusside

Answer 43

cGMP increased and inhibits Ca influx to relax sm mm cyanide toxicity- renal insufficiency

Question 44

phenylephrine norepinephrine vasopressin

Answer 44

alpha 1 agonist- rx hypotension norepi (levophed) alpha 1 and beta 1 agonist- vasoconstrict, increase co vasopressin (pitressin) ADH - septic shock

Question 45

Lipophilic statin

Answer 45

All but rosuvastatin and pravastatin | Crestor

Question 46

Enaxaparin bleeding

Answer 46

Protamine 1 mg/mg enaxaparin Incompletely reverses effects on Xa Reverses effect on thrombin (factor IIa )

Question 47

Eisenmingers and sildenafil

Answer 47

Drops co | Decreases walk time and increases r to left shunt

Question 48

Ranolozine interactions

Answer 48

CTP2D6 | Diltiazem

Question 49

Prasugrel cautions:

Answer 49

>75yo | Tia/cva

Question 50

Class 3 Dependency Channels

Answer 50

Ikr, Iks Increased block @ slower rates Reverse use dependency Increase QT