everything Flashcards
1st line for SVT
Diltiazam
Marked effect on AV
Verapamil
Greatest effect on art dilation
Nicardipine
the dihydropyridines
CCB:
Amlodipine
Nifedipine
Nicardipine
the non-dihydropyridines
CCB:
Diltiazam
Verapamil
who dilates art more than venous
CCB
who dilates venous more than art
nitrates at low doses
Nitrates hemodynamics
decrease preload/afterload, demand
increased coronary blood flow
improve LV compliance
BB hemodynamics
decrease CO, HR, contractility
metoprolol, atenolol SE
mask hypoglycemia warning signs
bronchospasms in asthmatics
do NOT abruptly dc
Atenolol not for kidney disease
CCB and IA cause what
myocardial depression and vasodilation
CCB hemodynamics
decreased HR (sa node) Dromotorpic (av node) Decreased conductivity inotropic-decrased contractility coronary and art dilation
Verapamil uses
SVT vasospastic angina HTN pulm HTN hypertrophic cardiomyopathy
metabolized by hepatic
nifedipine verapamil Nitro isosorbide monoitrate propranolol amiodarone phenytoin Atropine lido (Im PLAt PAm NNV)
metabolized by cp450
diltiazem
metoprolol
which diuretic has the most Na excretion
loop diuretics:
Furosemide
Bumetanide
Torsemide
which diuretic looses its effectiveness when creat clearance <30ml/min
“distat tubule” thiazide, metolaxone, Spironolactone
what MOA makes the diuretic a K sparing
decreased the Na/K exchange
what 2 drugs together need K monitoring bc both decreased K excretion
spironolactone and ACEI
which drug decrease mortality in HF
aldosterone antagonist diuretic (30%) other diuretics no.
ACEI
ARBs
hydralizine (af americ)
which has less decrease in Preload ACEI or ARBs
ARBs
Bidill is made up of which 2 drugs
Hydralazine (vasodilator) Isosorbide dinitrate (venodilator)
pts who don’t tolerate and ACEI can be on what?
Hydralazine
ARBs lack what compared to ACEI
lack bradykinin related vasodilation
the antidote to digoxin is
digoxin immune Fab
SE of digoxin bc of MOA
hypokalemia
MOA is: cardiac glucoside Na-Katpase inhibitor, increase PSNS activity, prolonged conductance through AV
increased risk of AV block with dig and…
bblocker
Abx do what to dig levels
decrease, speed up absorption
which drugs increase dig levels
Verapamil, Quinidine, Amiodarone
hemodynamics of Dobutamine
stimulation of B1: increased contractility
Stimulation of B2: art vasodilation Decreased afterload
phosphodiesterase inhibitors MOA
inhibit breakdown of cAMP and cGMP leading to increased amt of cGMP, cAMP=relaxation
hemodynamics of phosphodiesterase inhibitors
increase contractility
decrease afterload, preload, LVEDP (improved diastolic relaxation)
why can arrhythmias be caused by amrionone?
bc of the increased Ca
the phosphodiesterase inhibitor have what kind of therapeutic index
wide, to unlikely
what makes the difference btwn amrionone and milrinone
milrinone has less tachycardia and thrombocytopenia
hemodynamics of clonidine
decreased BP, CO (due to decreased HR, PVR)
Clonidine MOA
alpha2 agonist, decreased SNS outflow
Verapamil and B blockers place if risk of
AV block and HF.
Phase 0: drug class that works here
class 1abc
Phase 4: drug class that works here
class 2
Phase 2: drug class that works here
class 4
Phase:1,2,3 drug class that works here
class 3
Ia MOA
Intermediate Na blocker
prolonged repolar
decreased conduction velocity, deplor
increase AP duration
1b MOA
Fast Na Blocker
Shortens AP and refractory period
decrease automaticity
1c MOA
Slow Na blocker
decreased depolar rate and conduction
increased AP
inhibit conduction through His-Purkinje
which class 1a is not used bc of SE
procainamide
SE of disopyramide
CHF, hypotension
Lidocaine SE
hypotension, bradycardia
LA to effects: decreased CNS, drowsiness etc.
Lido theraputic [ ]
1-5mcg/ml
class 2 antiarrhy MOA
BB decrease depolar decrease SA discharge Slow speed of conduction though AV increase AP in atria decrease automaticity
excreted renally
nitro nifedipine dilt dig amrionone milrinone 80% clonidine 50% phenytoin lido 10% ACEI (Dig Dilt MAC Amri....then from the hepatic one PL NN)
excreted unchanged in urine
verapamil 70%
hydralazine <15%
Minoxidil 10%
esmolol is metabolized by what
plasma esterase
which drug has the longed e1/2t
amiodarone, 29days
class 3 MOA
block K channels prolonged depolar, refractory period increase AP, lengthing repolar decrease conduction velocity Increased QT internal decrease automaticity
amiodarone cardiac SE
hypotension, heart block, pro-arrhy: torsades
NOT for torsades
class 4 includes what type of drug and MOA
CCB AV node
decrease conduction through AV node
shorten phase 2 of vent myocyte
class 4 not for what arrhy
vent arrhy
pt on BB which CCB would be the best option and why
dilt. bc unlikely to interact with BB and less cardio depressant
which CCB has a shorter e1/2t
dilt
adenosine should not be giving in what patients
asthma
adensoine MOA
binds to A1 purine nucleotide receptor, activated receptors open K channels increases K currents, slows AV conductance
phenytoin is like what drug and tx what
resembles lido and class 1a torsades
atropine what type of drug
antimuscrinic
can penetrate BBB
which drug is antagonized by NSAIDs
captopril
what makes enalapril different from captopril
enalapril lacks sulfhydryl thus does not cause rash and renal insufficiency
what makes ARBs different from ACEI
ARBs have no effect on ACE, just block receptor.
Have less cough as side effect.
no significant bradykinin accumulation
hydralizine MOA
phthalazine derivative
activates gauntlet cyclase producing direct relaxation of vascular smooth muscle
what combo of drugs results in less SNS activity, less tachycardia and release of renin
Hydralzine or Minoxidil, BB and diuretic
Minoxidil MOA and cardiac SE
Directly relaxes the art of smooth muscle, little effect on venous capacitance
increase influx of K into cell causing depolar and dilation.
Can have abn ECG- flat or inverted T waves.
what drug is used for controlled hypotension technique?
nitroprusside
SNP MOA
DIRECT release of NO
SNP and oxyhbg dissociate to form Methemoglobin releasing NO and cyanide
NO activates gauntlet cyclase increasing cGMP
cGMP inhibits Ca entry into vascular sm but increases uptake of Ca into sER
NONselective relaxation of art and venous vascular sm
hemodynamics of SNP
Direct venous and art vasodilation
decreased SBP, SVR, PVR
increased contractility—causes an intracoronary steal
Baroreceptor mediated reflex increased HR
does NOT dilated coronaries
