CV Pharmacology 1 Flashcards
1
Q
Adverse Reactions iwth Fondarinux
A
Hemorrhage
Hypersensitivity
NO Thrombocytopenia
Osteoporosis if used long term
2
Q
Type of drug - Disopryamide
A
Class Ia: Na Channel Block
3
Q
Direct Thrombin Inhibitor - mechanism
A
Argatroban
Inhibits IIa without Antithombin III combination
4
Q
Diuretic effectivity
A
Loop+thia>Lopp>thia>AA
5
Q
Hyperkalemia
A
decreased AP duration and conduction Peaked T waves
6
Q
ADP Receptor Antagonists drugs
A
Clopidogrel (Plavix)
Ticagrelor
Prasugrel
7
Q
Heparin Overdose
A
Bleeding from nose, hematuria, bloody stools that leads to bruising.
Treatment is Protamine which neutralizes heparin in 5 minutes via IV at dose of <50 mg/10mines.
Incomplete reversal with LMWH
8
Q
Uses of nitrages
A
Acute Angina (sublingal or translingual spray for rapid action)
Prophylaxis for stable agina: long acting oral, topical, transdermal. Good if poor tolerance to Beta blockers or in combo with beta blockers
Perioperative hypertension
9
Q
what drugs have increased risk of hypokalemia
A
Loop diuretics, Thiazide, Digoxin
10
Q
How to treat irregular tachyarrhythmias?
A
Rate control, ani arrhythmics, cardioverson
11
Q
Dobutamine
A
beta agonist to use pt is hypotensive
12
Q
How do Class 3 drugs prolong refractory period?
A
increased phase 2 which leads to increase Na inactivation.
13
Q
Class 2 drugs
A
antagonist to Beta-AR to block sympathetic effect of NE to slow pacing HR and increase refractory period. Also inhibit cardiac remodeling.
14
Q
milrinone
A
Phosphodiesterase inhibitor to block cAMP degradation. use if on beta blocker.
15
Q
Effect of heart rate - CCB
A
Diltiazem > Verapamil at lowering
Nifedipine increases
16
Q
SE of adenosine
A
flushing, headache, AV block
17
Q
SE of Milrinone
A
hypotension, thrombocytopenia, arrhythmia, fever
18
Q
Type of drug - Furosimide
A
Loop Diuretic - blocks Na/K/Cl in transverse ascending loop
19
Q
Type of drug - Captorpril
A
ACE I
20
Q
Suppression of contractility - CCBs
A
Verapamil > Diltiazem > Nifedipine
21
Q
causes of atrial fibrillationg
A
hypertension, Mitral valve disease, Alcohol, cardiomyopathy, hyperthyroidism
22
Q
contraindications for Class 2
A
Asthma, CPOD
23
Q
Type of drug - Butetanide
A
Loop Diuretic - blocks Na/K/Cl in transverse ascending loo
24
Q
ENDING FOR BETA BLOCKERS
A
LOL
25
Vasodilators on HR
B blocks and diltizem decrease most, then verapamil
Nitrates and nifedipine increase
26
Antiplatelet drugs
Aspirin
Alopidogrel (ADP receptor antagonists)
Dipyridamole (blocks Phosphodiesterase)
Abcixibman (G IIb/IIA receptor blocker)
27
Type of drug - Diltiazen
Class IV, Ca Channel Blocker
28
Ranolazine - types and mechansim
Vasodilator
no effect on HR or BP
inhibits late Na current (prevent Na inactivation to prevent Na intracellular overloa dnad NCX reversal to increase Calcium to increas mechanism dysfunction and O2 demand.
29
dosing for ACE I
Lisinopril QD\> Enalatrpil BID \> Captopril TID
30
Nifedipine vs Verapamil vs. Diltiazen
Nifedpine is a dihydropyridine calcium channel blocker that works more on vascular SMC than carcia
The other two work on cardiac
31
Adenosine to Atrial Tachycardia
CHB, then could terminated.
32
Type of drug - Metoprolol
Beta- Blocker Class 2
33
uses of ACEI
hypertention, HF (HFrEF) and MI
34
Fondarinux - class and mechanism
Anticoagulant
Pentasaccharide activator of Antithrombin III to inactivate Xa
35
Class 1- Refractory period (A vs. B. vs C)
slower repolarization: 1A\>1C\> 1B (faster!)
36
Type of drug - Nifedipine
Class IV, Calcium Channel blocker
37
Inotropes Inotropy potential
NE\>Dopamien\>dobutamine\>milrinone
38
uses of Class II
V tach, SVT, A fib/flutter
39
Warfin - mechanism
acts in the liver to prevetn synthesis of Vitamin K dependnet factors (II, VII, IX, X) by preventing carboxyl group from being added to glutamyl reidicues.
Also inhibits Protein C synthesis - procoagulant effect.
40
Inotropes
Digoxin, dobutaine, milrinone, dopamine
41
Direct Xa inhibitors
Rivaroxaban
Adixaban
Edoxaban
42
Suppression of AV node - CCB
Verapamil \> Diltiazem
NO effect by nifedipine
43
SE of class IV
hypotension, digitalis toxicity
44
what mimics affect of adenosine
ACh on M2 receptors and Vagal maneuvers
45
Elimination of Dabigatran
80-85% renal excretion
Dosage adjustment for renal impairment of CrCl \<30
46
Treatment of digoxin toxicity
correct electrolytes, use antiarrthmic drugs, digoxin antibodies
47
Vasocilators on contractility
B blockers decrease the most with verapamil
Nifedipine and diltiazem stay the same or slight decrease
nitrates no effect
48
Adverse Rxs of CCB
cardaic arrect
AV block
CHF
bradycardia
Flushing
Edema, dizzy, N, constipation
49
Parmacokinetics of Reteplase vs. Tenecteplase
Reteplase: 2 doses, 30 minutes apart
Tenecteplase: single bolus
Prolonged duration compared to Alteplase
50
ARB vs ACEI
same effect, but no cough or angioedema. ARB block all AII production mechanisms (non renal ones)
51
Dabigatran overdose
first with antibody for reversal - IDARCUIZUMAB
52
Uses of Ranolazine
Add on for Agina - decrease symptoms of stable, increase exercise tolerance, substitute for beta blockers
53
Digoxin disadvantage in Rate control
does not control rate during exercise
54
Hypokalemia and diuretics
Loop + thia is greatest risk, Thia is lead. AA is hyperkalemia risk
55
use of Class 1b drugs
VT
56
Elimination of Heparin types
UFH, LMWH, Fondarinux, DTI
all except LMWH have short half life of 50-150 minutes and are reticuloendothelial cleared.
LMWH has a longer duration with 1-2 daily dose and Renally eliminated
57
Effects of ACEI
Vasodilation due to decreased AII and increased bradykinin Inhibits cardiac remodeling due to decreased aldosterone production
58
Route of administration of Unfractionated Heparin
IV or SC
IM is not used due to risk of hematomas
oral is not used due to poor bioavaliability
59
AT
atrial tachycardia due to a hotspot in atria
60
Type of drug - Hydrochlordothiazide
Thiazide diruetic - blocks Na/Cl in Distal Convoluted Tubule
61
Type of drug - Verapamil
Class IV, Ca channel blocker
62
Class III main drug
amidoarone
63
ARBs dosing
QD: losartan and candesartan BID: volsartan
64
Type of drug - Encainide
Class 1C Na Channel block - Discontinued
65
Type of drug -Volsartan
ARB
66
Type 4 HF
Congestion and hypoperfusion Cold and wet
67
Abciximab Route and risks
continous IV and risk of bleeding
68
Class II drugs main one
Propanolol, metoprolol
69
Adverse Reactions of Clopidogrel
GI upset, heacahce, dizziness, URI, BLEEDING\*\*
less effect of bleeding than prasugrel
if used with PPI, decreased activation
70
Drug interactions with Ivabradine
CYP3A4 and prolongs QT so proarrhythmic potential
71
AT1 receptors
GPCR with Gq
72
Adverse Rxns of Warfarin
Hemorrhage
necrosis of the fatty tissue
N, V, D\< cramping
Osteoporisis
73
Type I HF
Warm and dry
74
Tx differnce in A fibrillation vs. A flutter?
A flutter is treated like A fib, but harder to treat with meds. Catheter ablation is more successful than A fib and is considred curative with no anti-coags
75
AVRT
AV rentry tachycardia through accesory pathway. THis produces a delta wave becase ventricles depolarize before His/Purkinje doe.
76
Adverse rx of Ranolazine
prolong QT but not leading to torsades
77
Type of drug - Enalapril
ACE I
78
Plan for tx of A fib
1) reverse cause 2) rate control 3) anticoag 4) think about rhythm 50 think about ablation
79
Rate control
Class II and IV, digoxin (not in exercise)
80
Enoxapirin
LMWH
81
Coumadin
warfarin
82
main class 1B drug
lidocaine
83
ending for ACE I
PRIL
84
Adverse Rxns of nitrates
vasodilation: throbbing headache, orthostatic hypotension, flushing
Tachyphylaxis (tolerance) with continued exposure due to decreased nitrosothiol groups required for NO formation.
85
Antidromic AVRT
goes down accessory before AVN
86
Pharmacokinetics of Ranolazine
35-55% bioavaliabiligy
P glycoprotein efflux transporters
hepatically eliminated CYP3A4
BID
87
Type 3 HF
Hypoperfusion Cold and dry
88
Type of drug - Sotolol
Class III K channel blocker; with B blocker
89
Adenosine with ST
heart block then back to ST
90
what is the chronic treatment of bradyarrhythmoas?
pacemaker
91
Mechanism of Nitrates
Converted to NO (requires thiol and aldehyde dehydrogease).
NO acts on GC to increase cGMP and cuase relaxation.
Mimics the effect of ACh, bradykinin, histamine
Primary effect: decrease systemic resistance and decrease mycoardial oxygen requirement
secondary: increase perfusion of ischemic myocardium
92
what does adenosine terminate
AVNRT and AVRT
93
Syptomes of influsion of VIT K too fast
dyspnea, chest bain, back pain, death.
94
How often should Dabigatran be administered?
BID
has faster action that warfarin (2-3 days)
But missed does leads to thrombosis
95
Warfarin Overdose
Bleeding (hematuria, excessive menstruation, gum bleeding)
Therapeutic level \< INC \< 4.5 with no bleeding --\> hold 1doses
INF =4.5-10 - not bldding - hold 1-2 doses
INR \>10 but not bleeding: hold warfin and administer Vit K
Major bleeding: hold warfin and 5-10mg of Vitamin K
Prothobmin complex can be administered or VIIa factor but not Fresh frozen plasma
96
where do each diuetics act in the kidney?
loop - Trasnverse Ascending limb on Na/K/Cl transporter Thiazide distal convoluted tubule on Na/CL transpoter AA: in collecting tubute on Na/K/H transporter
97
Mechanism of Aspirin
Inhibition of COXI to decrease circulating levels of Thromboxame A2 (greater relative to COX2 prostaclycin synthesis).
Net effect: decrease clot formation
98
Adenosine to Junctional rhythm
nothing or termiante
99
SE of Aldosterone antagonists
Hyperkalemia and gynecomastia
100
Type of drug - Dopamine
Inotope - NE precursor
101
SE of entresto
angioedema
102
Rhythm control in atrial fibrillation
Class III, IC (not very good) Shock Catheter ablation
103
Tenecteplase - type and mechanism
fibrinolytic agent
binds to fibrin and plasminogen activating
Prolonged duration ofa ction compared to Altepase
More specific than Reteplase
104
105
First step in treating regalar tachyarrhythmias?
adenosine to diagnose or terminate. Terminates those involving the AV node by shutting off the AV node.
106
Type of drug - Carvedilol
Beta Blocker Class 2
107
Type of drug -Spironolactone
Aldosterone Antagonist/K Sparing diruetic; acts on Na/k/H transporter in Collecting Tubue
108
Inotropes tachyarrhythmia potential
NE\>Dopamien\>dobutamine\>milrinone
109
contraindications of ACEI
pregnancy, bilateral renal a. stenosis, hyperkalemia
110
Route of adminitartion of Dabigatran
Oral prodrug that is activated in plasma and liver
111
Reteplase - type and mechanism
Fibinolytic agent
modified form of tPA that has prolonged duration of action.
Less fibrin specific than tenecteplase
binds to fibrin to activate plasminogen
112
Supression of SA node CCB
Diltiazem = verapamil \> Nifedipine
113
Warfarin Contraindications
PREGNANCY!
hypersensitivty
thrombocytopenia
hemophilia
severe hypertension
bacterial endocarditis
114
main class 1C drug
fecidine and propafenone
115
Drug interactions that increase effects of warfarin
Increase pharmacokinetic: amiodarone, cimetidine fluconazole, fluoxetine, metronidazole, rosuvastatin
Increase pharmacodynamic (increase function): high dose aspirin, oral antibiotics
116
Type of drug - Ibutilide
class III K channel blocker
117
Prasugrel - mechanism
ADP receptor antagonists to decrease platelet aggregation
118
Inotropes HRincrease
NE\>Dopamien\>dobutamine\>milrinone
119
Epifibatide route and risk
continuous IV and bleeding
120
ending for ARBs
ARTAN
121
Uses of Dabigatran
Decrease Stroke and systmic embolism in non-valvular A fib. (NOT VTE)
A fib
122
hydralazine
vasodilator. Promotes hyperpolarization, inhibits IP3 release of Calcium, and stimulated formation of NO by vascular endothelium. Used on patients with persistent symptoms to decrease afte rload, work and regurgitation.
123
Side effects for Class 2
bradycardia, hypotension, AV block
124
Adverse reactions for Unfractionated Hemparin
Hemorrhage\*
Hypersensitivity
THrombocytopenia (mild is normal for 4 days, but severe is longer than 5-10 days).
Osteoporosis if used for longer than 6months
125
use of adenosine
SVTS with AV nodal reentry
126
Contraindications of Heparin
Hypersensitivity
Thrombocytopenia\*\*\*
hemophilia
active bleeding
severe hypertension
bacterial endocarditis
ulcers/GI
127
Treatments of AVNRT, ARVT, AT
adenosine for AVNRT and AVRT NOT AT Meds for all if Chronic: beta blockers, IV, I Cathetheter ablation for all
128
Contraindications of ARBs
pregnancy, high uric acid producers, hyperkalemia, rental A. stenosis
129
Uses of Warfarin
A fibrillation (nice becuase it can be reversed with vitamin K, but there is incredible dosage variablity, dietary restrictions, monitoring, drug interactions).
Prophylaxis of VTE especially with prosthetic valves
130
ARBs
selective inhibition of AT1 receptor to cause vasodilation (but less than ACEI no kinin)
131
Short acting Nitrates
Nitroglycerin and isosorbide dintrate sublingual
Nitroglycerin 10-30 minutes
Isosorbide dinitrate 10-60 minutes
132
Adverse Rxns of Dabigatran
Bleeding
GI: dyspepsia, gastritis
NOT GYP450 eliminated so no drug reactions
133
Tirofiban route and risk
Continuous IV and bleeding
134
what triggers late afterdepolarizations
Increased Ca due to ischemia, stress, digoxin toxicity, to activate NCX which leads to depolarization
135
Factor II , VII, IX, X turnover rates
VII (6 hr)\>IX (24 hr)\>X (40 hr) \> II (60 hr)
136
Type of drug - Candesartan
ARB
137
how shoudl ACEI be started?
with or after diuretics, low and titrate up
138
Unfractionated Heparin - type
anticoagulant
139
Class IV
L type Ca Channel blocks to decrease activation slope and increase refractory in node. Use dependent
140
Metabolism of Warfarin
99% plasma protein bound
CYP2C9 metabolism in liver
141
Uses of LMWH
used for same causes as unfractionated heparin
unstable angina or Acute MI
Prophylaxis fo VTE or post op TE
Prevent cerebral thrombosis
BUT does not require monitoring due to less complications with bleeding and thrombocytopenia
142
Adenosine to Atrial Flutter
CHB to flutter
143
what meds trigger bradyarrhythmias
Beta blockers, Calcium blockers, Anti-arrythmic, Clonidine, lithium
144
Use of Class Ia drugs
A fib and flutter, SVT
145
SE of dobutamine
Angina, tachy, dysarhythmia
146
Elimination of LMWH
longer duration that other types of heparin
only 1-2x daily dosing
Renally eliminated
147
what drugs trigger bradyarrhythmias?
Beta Blocks and Class IV, lithium, clonidine
148
What Class are use dependent
I and IV
149
Acute treatment of bradyarrhythmias
IV dopamine, IV isoproternolol, pacemaker
150
Treatement process of Bradyarrhythmias
1) Treat cause - ischemia, hypothyroidism, Lyme 2) Stop offending meds 3) Acute Tx if unsable with IV Beta-Agonists and transcutaneous pacing 4) Chronic: Pacemaker
151
Type of drug - Lisinopril
ACEI
152
Adverse Reactions of the LMWH
Hemorrhage
Hypersensitivity
THrombocytopenia (but less than unfractionated heparin)
Osteoporsis with \>6 months use
153
Admiodarone
Class III - with a long half life! also has class I effect and decreases slope of phase 4 SE: bradycardia, AV block, pulmonary fibrosis, hypothyrodism
154
Dipyridamole - mechanism and type
antiplatelet
Blocks phosphodiesterase to block cAMP breakdown.
This increases prosatcyclin activity.
NOT antithrombic
155
Meds for V Tach
Amidonarone, Lidocaine, Procainamide, Beta block, Calcium blocks
156
use of class 1c drugs
SVT and VT
157
Uses of CCB
Angina
Cardiac arrhyth ias
Hypertension
subarachnoid hemorrhage (nimodipine)
Premature labor (nifedipine)
158
Routes of the various kinds of Heparins:
UFH, LMWH, Fondarinux, DTI
all are IV or SC.
NOT IM or ORAL
159
When should you treat bradyarrhythmias?
when they are symptomatic or infranodal - like in type 2 secondary AV block or 3rd degree AV block.
160
When is an ICD necessary?
in chornic V-tach that shows structrual changes and is life treatening. when EF \<35% or \<35-40% with inducible VT or with hypertrophic CM, Congeital defects
161
Vasodilation effect of CCB
Nifedipine \> Verapamil \> diltiazem
162
Elimination of direct Xa inhibitors
Rivaroxaban: CYP3A4 (65%) + renal
Adixaban: CYP3A4 (50%) + renal
Edoxaban:high renal elminiation; not for CrCl \>95
163
Type of drug - Quinidine
Class Ia anti-arrhythmia: Na Channel Block
164
Type of drug - Torsemide
Loop Diuretic - blocks Na/K/Cl in transverse ascending loo
165
Type of drug - Phenytoin
Class 1B: Na Channel block
166
SE of hydralazine
Lupus like syndrome
167
what drugs inhibit cardiac remodeling
AA, Bblockers, ACEI
168
Type of drug - Propafenone
class 1C Na Channel Block
169
Contraindication so Ivabradine
pregnancy, A fib, AV block, low BP or HR, liver failure
170
Pharmacokinetics CCB
variable oral absorption
\>90% protein bound
CYP450 metabolism
171
Difference between generations in Beta blockers
1: nonselective for beta 2: selective for beta 1, 3: alpha
172
how to control rate in atrial fibrillation
1) cardiovert when hemodynamically compromised 2) Meds - Beta blockers, Digoxin, Calcium blockers, Amidoarone
173
Class 2 effect on ion channels
inhibit If, Ica and K
174
Entresto
Valsartan (ARB) with Neprilysin inhibitor - so is vasodilator and decreases conversion of BNP into inactive fragments. This promotes decrease in BP, and naturesis.
175
Special notes about heparin
does not cross the placenta
drug of choice for antiplatelet in pregnancy!
176
Treatment of heparin overdose
Protamine
\<50 mg/10minutes
177
Type of drug - Lidocaine
Class 1b: Na Channel Block
178
Type of drug - Ivabradine
New drug - lowers HR but not contraction (inotropy)
179
How often is Unfractionated Heparin administered
IV loading dose
with SC, there is a peak within 2-4 hours
Usually continous IV is perferred
180
Digoxin
inotrope that is used to control symptoms by inhibiting Na/K ATPase to decrease NCX function and increase intraceullar Ca to increase contractility. Also plays a role in baroreceptor expressions.
181
when does warfarin have max effect
3-5 days
182
Pharmacokinetics of Dipyradimole
Oral 3-4 QD before meals
183
AVNRT
AV nodal Rentry tachy where Atria and ventricles depolarize at same time
184
Main Class 1A drug
quinidine
185
Epifibatide - type and mechanism
blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.
Blocks all platelet activation pathway
Antiplatelet
186
Aggrenox
Combination of dipyridamole with aspirin
BID
187
Left ventricular volume effect of vasodilators
Beta block increases
Nitrates decrease the most
All CCB say same or slight decrease
188
what decreases digoxin effectivity?
rifampin, st. johns wort
189
what triggers early depolarizations?
Increased ICa-L
190
Ticagrelor - mechanism
ADP receptor antagonists to decrease platelet aggregation
191
Irregular tachyarrhythmias
A fib, mutifocal tachy arrh, A flutter
192
Pharmacokinetics of Ticagrelor
Prodrug activated by CYP450
Reversible inhibitor that is administerd orally BID with meals
193
Ivabradine
lowers HR but not contraction by decrease If in SA node.
194
Type of drug - Milrinone
Inotrope - Phosphodiesterase inhibitor to decrease cAMP hydrolysis
195
Clopidogrel - mechanism
ADP receptor antagonists to decrease platelet aggregation
196
Systpic Pressure vasocialtors
Nifedipine decrease the mos
then all else are equal
197
Type of drug - Digoxin
Inotrope - blocks N/K ATPase and controls baroreceptor concentrations
198
Class IV main drug
verapamil, Diltiazen
199
Fibrinolytic Agents
Alteplase
Reteplase
Tenecteplase
200
Type of drug - Entresto
new drug - and ARB ( Valsartan) + Neprilysin Inhibitor
201
ENDING FOR DIURETICS
IDE
202
Dabigatran - other names, mechanism and type
Pradaxa
Anticoagulant
Direct thrombin II inhibitor of Free and Clot bound thrombin
203
Class 1 - Na Channel block (A vs. B. vs. C)
slower depolarization 1C\>1A\>1B
204
what drugs have increase risk of hyperkalemia?
AA, ACEI, ARBs
205
Unfractionated Heparin - mechanism
indirectly activates antithrombin III to inhibit the actions of IIa and Xa
206
What exacerbates digoxin toxicity?
Class Ia and IV antiarrhthmics, Azole antifungals, macrolides
207
Drug interactions of Heparin
Increased bleeding with Anti-platelet aggregation:
Aspirin
Andomethacin
Ibuprofen
Dextran
208
Loop diuretics cause what ion loss?
K, H, Ca, MG, Urate
209
Risk Factors for Heparin types
All cause hemorrhage
RIsk of Hypersensitivity due to beef and pork origin
Thrombocytopenia
UFH\>LMWH; no risk with fondarinux
Osteoporsis with extended use (\>6 months)
210
Long acting nitrates
Nitroglycerin oral sustained 6-8 hrs
Nitroglycerin ointment 3-6 hours
nitroglycerin slow release buccal 3-6 hurs
Nitroglycerin slow release transdermal 8-10 hours
Isosorbide dintrate oral 4-6 hours
Isosorbide mononitrate 6-10 hours
211
Uses of Unfractionated Heparin
Adjunct treatment for unstable angina or acute MI
Prophylaxis for VTE (DVT/PE) or Post-Op TE
Prevent cerebral thrombosis
212
Thaizides cause what ion gain?
Ca and urate
213
Abciximab - type and mechanism
blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.
Blocks all platelet activation pathway
214
SE Of ACEi
Dry cough hypotension Angioedema hyperkalemia decreased renal function
215
Elimination of Unfractionated Heparin
T1/2 = 50-150 minute
Reticulo-endo clearance
216
Class III
K channel blockers to delay repolarization and prolong action potential; not use dependent
217
Treatment of V Tachyarrhythmia
if unstable shock, tx underlying cause and meds if stable, meds and tx underlying cuase
218
Adenosine action
binds to A1 to activate Gi to hyperpolarize membrane decreases HR and conduction rate specifically at AV node.
219
Tirofiban - type and mechanism
blocks G IIb/IIIA receptor to decrease aggregation between integrin and fibrinogen.
Blocks all platelet activation pathway
Antiplatelet
220
Uses of Direct Xa inhibitors
Prevent DVT in hip and knee replacement
Decrease stroke/embolis in non-valvular A fib.
A fib
Rivaroxaban: prevent VTE, and treatment of DVT/PE
221
Type of drug - Procainamide
Class Ia: Na channel block
222
Warfarin Route
Oral (100% abosrobed)
But with delayed effect due to factor turnover
223
Adverse Reactions of Apirin
Rare with low doses
Dyspepsia, N, V, GI bleeding
224
Type of drug - Dobutamine
Inotrope - Beta-agonist
225
Fondarinux Route
IV or SC
226
what is the acute treatment of bradyarrythmias?
Beta agonists - IV dopamine Transcutaneous pacing
227
Type of drug - Amidoarone
Class III K channel blocker with Class I effect
228
Advere Reactions of Direct Xa inhibitors
Bleeding
anticoagulation effect diffucl tto reverse
229
CLASS 1
use dependent Na blocks; decrease contractile velocity, increase refractory to decrease re-entry. Use dependent
230
Adverse Rxns with Prasugrel
GI upset, heacahce, dizziness, URI, BLEEDING\*\*
more effect of bleeding than clopidogrel
if used with PPI, decreased activation
231
decrease effect of warfarin - drug reactions
Increase metaboism: barbituates, carbamazpine, phenyton, rifampin, st johns wort
Decreased absorption: cholestryramine, colestipol
Pharmacodynamic: vitamin K
232
Aldosterone antaonists vs. other diuretics
K sparing diuretic to inhibit Na reabosprtion, but promote K and H reabsorption. and it is also antiremodeling.
233
Inotropes vasodilation potential
Milrinone\>Dobutamine\>dopamine\>Ne
234
Short acting dihydropyridines
increase angina- avoid them!
235
Digoxin toxicity
Above 1.2 ng/ml
Hypokalemia, hypercalcemia, Hypomagnesium
GI: N,V, D,
CNS: disorientation, hallucination, visual changes Gynecomasita
cardiac: bradycardia, Heart block, arrhythmic
236
Mechanism of Action of LMWH
binds directly to Antithrombin III to inactivate Xa (not so much IIa)
237
Dopamine
dose dependent - increase inotropy, pressor and renal function.
238
Type of drug - Losartan
ARB
239
what to do with unstable tachyarrhytmic patient?
shock!
240
Adverse Reactions of firbinolytic agents
Hemorrhage due to lysis of thrombi or systmic formation of plasmin to destroy fibrinogen, and factors V and VIII
Intracranial hemorrhage
241
Speical notes about Warfarin
Genetic polymorphisms exist!!
242
Route of administration of nitrates
Oral (sustained release): low oral bioavaliability due to first pass metabolism -\> requires higher dose every 4-8 hours.
Exclusion is isosorbide mononitrate
Sublingual: to cause rapid relief in 45 sec to 5 minues. Lasts for less than 30 minutes. Can repeast 3X every 5 min if no relief
Trasndermal: QD for 24 hour (remove at night)
243
what arrhythmia is terminated by adenosine or vagal manuever?
AVNRT AVRT
244
Type of drug -Epierenone
Aldosterone Antagonist/K Sparing diruetic; acts on Na/k/H transporter in Collecting Tubue
245
Type of drug - Adenosin
Anti arrhythmic - non classifed
246
Nitrate- Drug names
Ntiroglycernin
Isosorbide Mononitrate
Isosorbide Dinitrate
247
Type of drug - Flecinide
Class 1C Na Channel Block
248
Rhythm control
III or IC, shock, catheter ablation
249
Chronotropic incompetence
malfunction of SA node to not reguarly increase HR during exercise
250
Side effect of Dipyridamole
Minimal
Dizzy, GI distress
251
Primary VT treatment?
cardioabaltion and meds
252
Route of Direct Xa inhibitors
Orally
Rivaraoxaban QD
Adixaban BID
253
when should aldosterone antagonists be used?
when LVEF is less than 30% or after ACEI and B blocker is ineffective.
254
Prasugrel - pharmacokinetics
prodrug activated by CYP450
irreversible inhibitor
QD orallys
255
Pharmacokinetics of Clopidogrel
Produg that is activated by CYP450 that acts as an irreversible inhibitor.
QD orally
256
hypokalmeia
increased HR and AP duration, increase sensitivity to Class III results in U waves and digoxin tocity
257
Quinidine - Side Effects
promotes digitalis toxicity due to inhibitiion of P glycoprotein to lead to torsades de pointes and VT.
258
Orthodromic AVRT
goes down AVN before accessory
259
Type 2 HF
Congestion Warm and west
260
what drugs decrease digoxin metabolism?
quinidine, verapamil, diltiazen
261
Beta blocker dosing
Metaprolol, bisoprolol are both QD Carvedilol: BID
262
Type of drug - Bisprolol
Beta-Blocker Class 2
263
Alteplase - Type and mechanism
Fibinolytic agent
Human Tissue plasminogen activator (tPA)
binds to fibin to activate plasminogen - clost selective
264
Adverse Rxns with Ticagrelor
GI upset, heacahce, dizziness, URI, BLEEDING\*\*
if used with PPI, decreased activation
265
Thiazide vs. Loop diuretics Ca
Ca is excreted in loop, but retains in thiazides via parathyroid hormone.
