CVS DRUGS Flashcards

Question

tell me about aminophylline

Answer 1

non selective phosphodiesterase inhibitor. increases cAMP and hence PKA works as bronchodilator in asthma but also an ionotrope in cardiogenic shock usually give a loading dose and then maintainance dose. ensuring levels are closely monitored due to its narrow therapeutic index. pharmacodynamics - bronchodilation - ionotropy, tachycardia, vasodilation - neurologicallly - can reduce seizure threshold pharmacokinetics - IV or PO - good BO - CYP450 metabolism - 0 order kinetics in toxic dose - narrow therapeutic index - hence needs HDU for infusion.

Answer 2

milronone and enoximone these act only on myocardium and vascular smooth muscle. hence increase ionotrophy and used in cardiogenic shock.

Answer 3

indirect sympathomimetic works via promoting vesicles of NA to be released used commonly in threatre for hypotension treatment. comes in 30mg in 10ml vials - given as 2-3ml bolus's also comes as tablets and nasal drops. overall effects include - positive ionotrophy and chronotrophy - vasopressor - bronchodilation tachyphylaxis is seen - once NA stores are exhausted.

Answer 4

the parasympathetic NS acts via muscarinic receptors = M1 to M5 drugs can either act as agonist or antagonists to these agonist * pilocarpine - used for glaucoma antagonists - structurally related to Ach - atropine - bradycardia, - glycopyrolate -bradycardia, secretion - hyoscine - buscopan, secretions - ipratropium - asthma. some drugs can act indirectly e.g. acetylcholinesterase inhibitors - neostigmine e.g. affect ACh release - botilinum toxin, Mg, Gentamicin

Answer 5

both have an amine group atropine is a tertiary amine i.e. not charged glyco is a quarternary amine and charged therefore atropine can cross BBB and have central efects. - sedative and delirium in elderly.

Answer 6

respiratory - bronchodilation - reduced secretions cardio - tachycardia GI - reduced peristasis - constipation CNS - restlessness, agitation, delirium , sedation opthalmic - pupil dilation - avoid in glaucoma

Answer 7

mAChR antagonist tertiary amine used for bradycardia, part of ALS IV preparation - clear colourless solution, 1ml ampules containing 0.6mg. usually given as 0.2-0.6mg. pharmacodynamics - block parasymp - do by system. pharamacokinetics - crosses BBB and placenta

Answer 8

mAChR antagonist quarternary amine used for bradycardia and to reduce secretions e..g paliative care, slower onset than atropine IV preparation - clear colourless solution, 1ml ampules containing 200ug. can give 200-400micrograms pharmacodynamics - block parasymp - do by system. pharamacokinetics - doesnt crosses BBB and placenta

Answer 9

mAChR antagonist used in N&V, dizziness, antispasmodic, premed as it causes sedation and amnesia. 2 forms - one can cross BBB and one cant e.g. hyoscine butylbromide cant this is buscopan. hydrobromide can.

Answer 10

sympathomimetic - drugs that stimulate adrenoreceptors and hence mimic effects of sympathetic NS. May be endogenous or synthetic catecholamines or synthetic non catecholamines. sympatholytic - block adrenoceptors and block effects of Symp NS

Answer 11

synthetic directly acting catecholamine B1 and B2 receptors ionodilator - B1 chrono and ionotrophy, B2 - some vasodilation but BP mostly maintained good for cardiogenic shock. also used in the stress test instead of exercise has a very short half life because of its rapid metabolism by COMT - therefore given as an infusion

Answer 12

can be classed according to site of action blood vessels * nitrates, CaCB (amlodipine), a1 blocker (doxazocin) heart * B blockers - indirect can reduce MAP by reducing CO. RAAS: * ACE inhibitors * ARBs kindeys * diuretics centrally acting * a2 = clonidine , dexmedetomidine, methyldopa

Answer 13

Glyceryl trinitrate, isosobide mononitrate, sodium nitroprusside arterial and venous dilation reduce afterload and SVR. therefore reduces MAP. also reduced preload - hence CO - hence MAP MAP = CO x SVR GTN - acute angina releif long acting nitrates = isosorbide mononitrate = prophylaxis for angina sodium nitroprusside - HTN crisis

Answer 14

promote diuresis... less ATII and so less ADH and aldosterone release and hence less Na reabsorption. reduces blood volume hence preload --> CO --> MAP also less ATII normally vasoconstriction therefore ACEi inhibit this.

Answer 15

labetolol methyldopa nifedipine

Answer 16

stage 1 BP more than 140/90mmHg or at home 135/85 stage 2 - 160/100, 150/95 stage 3 - 180 systolic or 120 diastolic .

Answer 17

stage 4 is add in others e.g. spironolactone, alpha blocker.

Answer 18

hypotension headache flushing constipation tolerance

Answer 19

HOCM severe AS

Answer 20

non-dihydropyridine CCB (class I) * mostly act by blocking SAN/AVN and lowering HR * verapamil dihydropyridine CCB (clas II) * work on vascular smooth muscle * e.g. amlodipine , nifedipine * HTN, raynauds, cerebral vasospasm class III - diltiazem - works on both peripheral and cardiac both work via blocking Ca entry via L type Ca channels.

Answer 21

inorganic nitrate used in HTN emergenceies brown powder that needs reconstituiting in dextrose donates NO in vivo main problem is it degrades in sunlight so needs opaque giving sets and produces cyanide ions both arterio and venodilation - reduced SVR/ MAP and preload

Answer 22

cyanide is a toxic inorganic molecule c triple bond N it can cause histocytic hypoxia binds to ETC carrier molecules and blocks their action hence blocks oxidative phosphorylation leads to metabolic acidosis

Answer 23

Often first line medication for HTN Also used for their cardiac remodelling potential and so used after MIs block conversion of ATI to ATI and therefore work as a diuretic and vasodilator to reduce BP common side effects include * low BP/ orthostatic hypotension * high K * dry cough * precipitation of AKI * angioedma e..g. ramipril, enalopril, lisinopril

Answer 24

reversible cause.. * treat pain * treat hypercapnoea * reduce ET cuff pressure if high indirect * anaesthetic agent - inhalation or propofol * opioids * MgSO4 direct: * labetolol - 5 to 10mg IV increments/ infusion * hydralazine * GTN infusion

Answer 25

MAP 65 in most people due to autoregulation of CPP occuring between 50-150mmHg may be higher in chronic HTN, cerebrovascular disease etc. too low - may not perfuse vital organs such as the brain too high - can result increased bleeding intraopertively

Answer 26

elective in community - less than 160/100 mmHg on the day - less than 180 / 110 mmHg

Answer 27

no longer used block nAChR sympathetic ganglia and result in hypotension.

Answer 28

anti HTN medication often used in treatment of pre-eclampsia works via inhibition of guanyl cyclase and thus causes vasodilation. - reduces SVR. also thought to interfere with IP3 pathway and reduces intracellular calcium can be given IV or orally long term it is associared with SLE

Answer 29

IV or oral or as adjunct in neuroaxial anaesthesia.

Answer 30

hypotension sedation analgesia reduces MAC, paradoxical HTN, rebound HTN, antiemetic, anxiolysis

Answer 31

inorganic ionic molecule with many uses - * analgesia * hypotension * prolongs NMBA * antiarrhyhmic - torsades, AF * bronchodilator - asthma management 2nd line * reduces seizure activity * 1st line for pre-eclampsia and eclampsia presented as 50% MgSo4 in 2,5,10ml ampoules which requires dilution. usually give 2-4g IV it works via antagonism of calcium hence reduces neuronal transmission and relaxes smooth muscles.

Answer 32

most abundant intracellular cation after K found in soft tissue and muscle and bone

Answer 33

CVS system * vasodilation - hypotension * antiarrhythmic CNS * reduces excitability - increases seizure threshol * hypoMg - causes vasospasm respiratory * bronhcodilation - via relaxing smooth muscle. MSK * hyporeflexia, muscle weakness other * inhibits catecholamine release * inhibits platelets

Answer 34

mild more than 4mM = nausea, hyporeflexia , slurred speach moderate - 4 to 10 = muscle weakness, resp depression, bradycardia severe- more than 10 = cardiac arrest

Answer 35

effective intro op adjunct for analgesia thought to be via comp and non-comp NMDA anatagonism preventing transmission in spinal cord

Answer 36

hypo K should replace Mg before replacing K as Mg deficiency exagerates renal K excretion and impairs Na/K ATPase

Answer 37

both drugs act on RAAS ACEi = block ACE and conversion of ATI I to II. therefore reduce amounts of ATII and downstream effects - aldosterone production, vasoconstriction, ADH secretion ARB - block the ATII receptor. and thus also reduce effects but not levels of ATII side effect profile slightly different ACEi promote bradykinin production and thus dry cough and angioemdma is more common ARB have a better side effect profile both can still cause hypotension, hyperkalaemai. both can be used in HF, post MI and HTN. usually ACEi first line and ARBs if they arent tolerated

Answer 38

nicorandil is an example used as prophylaxis in angina and HF activates ATP sensitive K channels within heart and arterioles. promotes hyperpolarisation, closing VG ca channels thus vasodilation, reduces AP duration.

Answer 39

tumour of chromaffin cells exagerrated sympathetic response thus intermittent - HTN, tachycardia, sweating, flushing. treated with sympatholytics - alpha and beta blockade need to block alpha before beta receptors. otherwise will have very high afterload that the heart can't deal with after B blockade. plus blocking B2 as well and reduced vasodilation, worsens BP. e.g. doxazocin and bisoprolol

Answer 40

B blockers/ Ca CB B blockers plus type 2 CCB long acting nitrate pottasium channel activator (nicorandil)

Answer 41

Morphine oxygen - titrated nitrates - GTN spray Aspirin - 300mg definitive - PCI or fibrinolysis (PCI if it can be made within 120 mins of diagnosis, otherwise fibrinolysis) after PCI / stenting - Dual antiplatelet - asprin + clopi for for 6months - 1 yrs. then aspirin only.

Answer 42

absolute * previous intracranial bleed * ischaemic stroke within 6 months * recent major trauama/ surgery * GI bleed in last month * known bleeding disorder * aortic dissection relative * recent TIA * oral anticoags * refractory HTN * active peptic ulcer * I.E * advanced liver disease

Answer 43

block HMG CoA reductase prevent cholesterol synthesis

Answer 44

Vaughn william classification - traditionally class I = VG Na blockers, all reduce phase 0 of AP. * 1a = increase refractory period + AP - quinidine, procainamide * 1b= decrease refractory P + AP - lidocaine, phenytoin * 1c = no effect on RP + AP - flecainide class 2 = B blockers - atenolol, bisoprolol class 3 = K channel blockers - amiodarone, sotolol class 4 = Ca CB - verapamil, diltiazam

Answer 45

many anti-arrhyhmics drugs dont fit into this classification e..g digoxin , MgSO4, adenosine some fit into multiple categories e.g. sotolol

Answer 46

by indication SVT - adenosine, digoxin, B blockers, verapamil VT - lidocaine, phenytoin both - amiodarone, flecainide by molecular targer - ion channels - flecaindide, lidocaine, amiodarone - pumps/carriers - digoxin - receptors - B blockers, adenosine

Answer 47

draw cardiac AP class I a - increase RF and AP and reduce phase 0 class Ib - decrease RF and AP and reduce phase 0 class Ic - minimal affect AP/RF , reduce phase o class II - reduce funny current, slow automaticity , prolong AP duration Class III - reduce phase 3, prolong AP and refractory class IV - reduce automaticity, slow phase 0 of pacemaker, prolong AP and refractory

Answer 48

1a - intermediate dissociation 1b - fast dissociation, weak block 1c - slow dissociation, strong block

Answer 49

LAST * neuro - lip tingling, tinnitus, agitiation, tremor, seizure. excitatory at first. then inhibitory - drowsiness, apnoea, coma * cardiac - low BP, low HR, arrhythmias (torsade)

Answer 50

SELECTIVE to B1 = BEAM bisoprolol, esmolol, atenolol, metoprolol non selective e.g. labetolol to alpha 1 as well e.g. propanolol - b1 and b2

Answer 51

flushing, bradycardia, constipation, ankle oedema , reduced contractility - caution in HF

Answer 52

class III antiarhythmic agent workss via blocking VG K channels and hence acts at phase 4 of the cardiac AP used predominately in ventricular arrhtyhmias given as IV or oral preparation. usually requires a loading dose in an emergency due to very long half life. e.g. 300mg loading dose given in acute setting IV followed by 900mg over 24 hours. - via central line pharmacodynamics * useful effects - prolongs AP and RF , good at blocking accessory pathways e.g. for WPW. * however * can increase QTand precipitate torsades, lower HR and BP * resp - pneumonitis + fibrosis * liver - hepatitis, cirrhosis * thyroid - hyper/hypothyroid * CNS - peripheral neruopathy, corneal deposits * skin - photosensitivity and slate grey skin should do baseline TFTs, CXR, LFTs, UEs before use pharamcokinetics * oral - 50% BO * high PB - displaces gixonix, DOACs, CCB etc * long half life - 50 days hence loading dose * hepatic metabolism * biliary, skin secretion.

Answer 53

digoxin is a cardiac glycoside it blocks the NA/K ATPase and acts as an anti-arrhythmic agent and a ionotrope and hence mostly used for HF and AF it is given either orally or IV. levels need to be closely monitored due to its narrow therapeutic range and toxicity outside of this. pharmacodynamics - can cause arrhythmias, nausea, vomitting, visual distrubances (green) in toxic doses pharmacokinetics - IV or oral - large vd - renal excretion unchanged toxicity can be treated with digibind - monoclonal Ab supportive - electrolyte corrections, phenytoin to treat arrhythmias

Answer 54

WPW is a congenital condition whereby there is an accessory pathway between A and V. hence can get antidromic and orthodromic conductions loops - down AVN and up accessory path - can lead to re-entry tachycardias. in those with AF - there is increased risk of SVT if the AVN is blocked via adenosine, digoxin, CaCB it will encourage rapid transmission of impulses down accessory pathway and may allow for AF to cause VT or VF. should use amiodarone in these patients

Answer 55

abnormal cardiac channels promote VF and sudden cardiac death pre-op considerations - check and correct electrolytes, avoid LA agents treat VF/VT with defibrilation

Answer 56

used both in the acute setting and primary care.. can be divided by system CVS: * AF, angia, post MI, HTN endocrine: * pheochromocytoma * hyperthyroid CNS: * anxiety * glaucoma * migrane propjylaxis * essential tremor

Answer 57

by system work via blocking B1 and B2 receptors depending on selectivity heart - negative chronotrophy = bradycardia (SAN and AVN negative ionotrophy = reduced contractility hence CO and hence hypotension increase SVR - due to B2 normally causes vasodilation - hence reduced coronary blood flow lungs beta 2 - bronchospasm RAAS - block renin production neuro - fatigue , nightmares metabolic - reduce glycolysis, gluconeogensis ocular - reduced ocular pressure

Answer 58

atenolol - 2.5mg metoprolol - 5mg labetolol - 5mg esmolol - 10mg

Answer 59

inhibits the Na⁺/K⁺-ATPase, leading to: Severe intracellular calcium overload. Cellular membrane instability and increased automaticity, which can cause life-threatening arrhythmias.

Answer 60

discontinue supportive care correct electrolytes digibind haemodialysis is not used unless for renal failure and hyperkalaemia

CVS DRUGS Flashcards

anti-arrhythmics, ANS drugs, CVS drugs