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1
Q

1st line for SVT

A

Diltiazam

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2
Q

Marked effect on AV

A

Verapamil

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3
Q

Greatest effect on art dilation

A

Nicardipine

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4
Q

the dihydropyridines

A

CCB:
Amlodipine
Nifedipine
Nicardipine

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5
Q

the non-dihydropyridines

A

CCB:
Diltiazam
Verapamil

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6
Q

who dilates art more than venous

A

CCB

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7
Q

who dilates venous more than art

A

nitrates at low doses

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8
Q

Nitrates hemodynamics

A

decrease preload/afterload, demand
increased coronary blood flow
improve LV compliance

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9
Q

BB hemodynamics

A

decrease CO, HR, contractility

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10
Q

metoprolol, atenolol SE

A

mask hypoglycemia warning signs
bronchospasms in asthmatics
do NOT abruptly dc
Atenolol not for kidney disease

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11
Q

CCB and IA cause what

A

myocardial depression and vasodilation

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12
Q

CCB hemodynamics

A 
decreased HR (sa node) 
Dromotorpic (av node) 
Decreased conductivity 
inotropic-decrased contractility 
coronary and art dilation
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13
Q

Verapamil uses

A 
SVT
vasospastic angina 
HTN
pulm HTN
hypertrophic cardiomyopathy
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14
Q

metabolized by hepatic

A 
nifedipine
verapamil
Nitro
isosorbide monoitrate
propranolol
amiodarone
phenytoin
Atropine 
lido
(Im PLAt PAm NNV)
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15
Q

metabolized by cp450

A

diltiazem

metoprolol

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16
Q

which diuretic has the most Na excretion

A

loop diuretics:
Furosemide
Bumetanide
Torsemide

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17
Q

which diuretic looses its effectiveness when creat clearance <30ml/min

A

“distat tubule” thiazide, metolaxone, Spironolactone

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18
Q

what MOA makes the diuretic a K sparing

A

decreased the Na/K exchange

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19
Q

what 2 drugs together need K monitoring bc both decreased K excretion

A

spironolactone and ACEI

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20
Q

which drug decrease mortality in HF

A

aldosterone antagonist diuretic (30%) other diuretics no.
ACEI
ARBs
hydralizine (af americ)

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21
Q

which has less decrease in Preload ACEI or ARBs

A

ARBs

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22
Q

Bidill is made up of which 2 drugs

A 
Hydralazine (vasodilator)
Isosorbide dinitrate (venodilator)
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23
Q

pts who don’t tolerate and ACEI can be on what?

A

Hydralazine

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24
Q

ARBs lack what compared to ACEI

A

lack bradykinin related vasodilation

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25
the antidote to digoxin is
digoxin immune Fab
26
SE of digoxin bc of MOA
hypokalemia | MOA is: cardiac glucoside Na-Katpase inhibitor, increase PSNS activity, prolonged conductance through AV
27
increased risk of AV block with dig and...
bblocker
28
Abx do what to dig levels
decrease, speed up absorption
29
which drugs increase dig levels
Verapamil, Quinidine, Amiodarone
30
hemodynamics of Dobutamine
stimulation of B1: increased contractility | Stimulation of B2: art vasodilation Decreased afterload
31
phosphodiesterase inhibitors MOA
inhibit breakdown of cAMP and cGMP leading to increased amt of cGMP, cAMP=relaxation
32
hemodynamics of phosphodiesterase inhibitors
increase contractility | decrease afterload, preload, LVEDP (improved diastolic relaxation)
33
why can arrhythmias be caused by amrionone?
bc of the increased Ca
34
the phosphodiesterase inhibitor have what kind of therapeutic index
wide, to unlikely
35
what makes the difference btwn amrionone and milrinone
milrinone has less tachycardia and thrombocytopenia
36
hemodynamics of clonidine
decreased BP, CO (due to decreased HR, PVR)
37
Clonidine MOA
alpha2 agonist, decreased SNS outflow
38
Verapamil and B blockers place if risk of
AV block and HF.
39
Phase 0: drug class that works here
class 1abc
40
Phase 4: drug class that works here
class 2
41
Phase 2: drug class that works here
class 4
42
Phase:1,2,3 drug class that works here
class 3
43
Ia MOA
Intermediate Na blocker prolonged repolar decreased conduction velocity, deplor increase AP duration
44
1b MOA
Fast Na Blocker Shortens AP and refractory period decrease automaticity
45
1c MOA
Slow Na blocker decreased depolar rate and conduction increased AP inhibit conduction through His-Purkinje
46
which class 1a is not used bc of SE
procainamide
47
SE of disopyramide
CHF, hypotension
48
Lidocaine SE
hypotension, bradycardia | LA to effects: decreased CNS, drowsiness etc.
49
Lido theraputic [ ]
1-5mcg/ml
50
class 2 antiarrhy MOA
``` BB decrease depolar decrease SA discharge Slow speed of conduction though AV increase AP in atria decrease automaticity ```
51
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) ```
52
excreted unchanged in urine
verapamil 70% hydralazine <15% Minoxidil 10%
53
esmolol is metabolized by what
plasma esterase
54
which drug has the longed e1/2t
amiodarone, 29days
55
class 3 MOA
``` block K channels prolonged depolar, refractory period increase AP, lengthing repolar decrease conduction velocity Increased QT internal decrease automaticity ```
56
amiodarone cardiac SE
hypotension, heart block, pro-arrhy: torsades | NOT for torsades
57
class 4 includes what type of drug and MOA
CCB AV node decrease conduction through AV node shorten phase 2 of vent myocyte
58
class 4 not for what arrhy
vent arrhy
59
pt on BB which CCB would be the best option and why
dilt. bc unlikely to interact with BB and less cardio depressant
60
which CCB has a shorter e1/2t
dilt
61
adenosine should not be giving in what patients
asthma
62
adensoine MOA
binds to A1 purine nucleotide receptor, activated receptors open K channels increases K currents, slows AV conductance
63
phenytoin is like what drug and tx what
``` resembles lido and class 1a torsades ```
64
atropine what type of drug
antimuscrinic | can penetrate BBB
65
which drug is antagonized by NSAIDs
captopril
66
what makes enalapril different from captopril
enalapril lacks sulfhydryl thus does not cause rash and renal insufficiency
67
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
68
hydralizine MOA
phthalazine derivative | activates gauntlet cyclase producing direct relaxation of vascular smooth muscle
69
what combo of drugs results in less SNS activity, less tachycardia and release of renin
Hydralzine or Minoxidil, BB and diuretic
70
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.
71
what drug is used for controlled hypotension technique?
nitroprusside
72
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
73
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

Pharm test 3 (6 decks)

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