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Cardiology > Cardiac Pharmacology > Flashcards

Cardiac Pharmacology Flashcards

1
Q

nitrates

A

action cgmp pathway at smooth mm level

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2
Q

ranolozine

A

increases qt

contraindicated in liver disease

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3
Q

clopidogrel pharmacokinetics:

A

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

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4
Q

clopidogrel resistance

A

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

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

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5
Q

abciximab

A

repro

severe thrombocytopenia

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6
Q

eptifibatide

A

integrelin
2b3a inhib
similar to tirofiban

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7
Q

thrombolyitics pharm

A

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

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8
Q

antiarrythmics- class 1

A

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

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9
Q

quinidine:

A 
class 1a
decreases automaticity, prolong qrs, qt, increase sinus rate
need av nodal blocker first
itp, torsades de pointes
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10
Q

procainamide

A

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

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11
Q

disopyramide

A 
1a
quinidine like
slow sinus rate
neg inotropic- ppt chf- may use in HOCM
parasymt interaction- urin retention, torsades
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12
Q

lidocaine

A

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

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13
Q

flecainide

A

1c
depresses rapid upstroke of AP slows conduction
proarrhythmic

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14
Q

propafenone

A

b blocking
1c
similar to flecanide
avoid ischemic use

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15
Q

sotalol

A

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

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16
Q

amiodarone toxicity

A

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

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17
Q

dronedarone

A

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

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18
Q

thiazide/ thiazide like

A

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

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19
Q

chlorthalidone

A

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-

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20
Q

adverse effects of thiazides

A 
lytes
gout
blood dyscrasias
photosenstivity
lithium toxicity, worsens dm, increases ldl and tg
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21
Q

ethacrynic acid

A

loop diuretic without sulfa

22
Q

loop diuretic mechanism of action

A

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

Ototoxicity: worse with ethrynic acid- permanent

23
Q

furosemide

A

poor gut absorption

bumetanide/torsemide 90%absorption

24
Q

sprironlactone

A

aldosterone antagonist and reduces Na reabsorption

amy interfere with steroid synthesis gyneocomastia

25
Q

diuretic therapy for hypertension in renal insufficiency

A

thiazides ineffective with gfr <30

metolazone may work

26
Q

alpha meds for htn

A

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

27
Q

cardioselective b blockers

lipid solubility:

A

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

28
Q

vasodilating b blockers

A

labetolol, carvedolol

29
Q

metoprolol succinate

A

long acting

survival benefit in chf- not shown with tartrate

30
Q

angiotensin CE location

A

ubiquitous
endothelial
angiotensin 1 to angotensin 2

31
Q

angiotensin 2 actions

A

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

32
Q

RAS levels with ace inhibitor

A

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

33
Q

aliskiren

A

tekturna

direct renin inhib, so blocks angiotensinogen to AG1

34
Q 
different effects on RAS:
diuretic
acei
arb
dri
A

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

35
Q

clonidine

A

alpha 2 agonist
decreases symptathetic outflow- cns effects

alpha methyl dopa

36
Q

minoxidil

A

reflex tachy needs b blocker
volume retention
pericard effusion

37
Q

statin metabolism

A

atorvastatin, simvastatin, pravastatin
cyp450 3a4 metabolized

grapfruit juice, protease, macrolid abx interaction

38
Q

colesevelam

A

bile acid sequestrant

binds 2 sites

39
Q

fibric acid therapy

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

digoxin toxicity

A

not removed with dialysis
digibind rx
amio will increase levels

41
Q

digoxin action

A

na/k atpase and decreases function

increases vagal activity

42
Q

milrinone

A

phosphodiesterase inhibitor- inhibits PDE3 so increases cAMP
(cAMP degraded by PDE3 to AMP)

increases intracellular Ca and contractility and vasodilates

43
Q

nitroprusside

A

cGMP increased and inhibits Ca influx to relax sm mm

cyanide toxicity- renal insufficiency

44
Q

phenylephrine
norepinephrine
vasopressin

A

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

45
Q

Lipophilic statin

A

All but rosuvastatin and pravastatin

Crestor

46
Q

Enaxaparin bleeding

A

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

47
Q

Eisenmingers and sildenafil

A

Drops co

Decreases walk time and increases r to left shunt

48
Q

Ranolozine interactions

A

CTP2D6

Diltiazem

49
Q

Prasugrel cautions:

A

> 75yo

Tia/cva

50
Q

Class 3
Dependency
Channels

A

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

Cardiology (15 decks)

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