Pharm Flashcards
Which statin is most effective in reducing LDL levels?
Atorvastatin
ARSPLPF
Describe Class 1B Antiarrhythmic drugs
Lidocaine and Mexiletine
- block sodium channels
- State dependent block (bind to inactivated sodium channels)
- preferentially bind to depolarized cells
- May shorten action potential
- Do not block potassium channels, do not prolong action potential or QT duration on ECG
Describe Class 1A Antiarrhythmic Drugs
Quinidine, Procainamide, Disopyramide
- Block sodium channels
- Bind to Activated (open) sodium channels
- Target ectopic pacemaker cells
- Block potassium channels
- Prolong action potential, QRS/QT intervals
Describe Class 1C Antiarrhythmic Drugs
Flecainide, Propafenone
- Block sodium channels
- Bind to activated (open) sodium channels
- Dissociate from channel with slow kinetic
- Do not prolong action potential and QT
- Prolong QRS interval duration
Amiodarone
- Metabolized by CYP3A4
- inhibits a bunch of cyp enzymes
- can cause fatal pulmonary fibrosis, hepatitis, photodermatitis
What is the MOA of beta-blockers when used for angina?
Decrease in HR leads to improved myocardial perfusion and reduced oxygen demand, decreased contractility, reduced afterload
What are adverse effects of beta-blockers?
- reduced cardiac output
- bronchoconstriction
- impaired liver glucose mobilization
- unfavorable blood lipid profile
- sedation/depression
What are contraindications for beta-blocker use?
- asthma
- peripheral vascular disease
- type 1 diabetics on insulin
- bradyarrhythmias and AC conduction abnormalities
- Severe depression of cardiac function
What are some indications for adrenomimetics? Which drugs can be used?
Increase blood pressure (-ines), heart failure (dobutamine and then dopamine), HTN, emergency therapy (epi/iso), Narcolepsy (amphetamines), ADHD, obesity, bronchial asthma (albuterol), decongestion of mucous membranes, anaphylaxis, opthalmic applications, incontinence
What is the pathway associated with a1 adrenergic receptors?
Gq protein, increase IP3 and DAG
What is the pathway associated with a2 adrenergic receptors?
Gi protein, decrease cAMP
What is the pathway associated with B type adrenergic receptors?
Gs protein, increase cAMP
What are the pathways associated with dopamine type adrenergic receptors?
D1 and D5 increase cAMP
D2-4 decrease cAMP
What are the pharmacodynamic effects of Epinephrine?
- Increase contraction force
- increase heart rate
- Increase conduction velocity
- Increases systolic BP
- relaxes bronchial muscle
- causes muscle tremor
- increases K uptake by skeletal muscle
- elevates blood glucose levels
What are the pharmacodynamic effects of Norepinephrine?
- Potent cardiac stimulant but reduces heart ratae
- Potent vasoconstrictor
- Lacks B2 agonist effects (no bronchodilation and vasodilation)
- Increases PVR and BP
- Role of baroreflex
What are the pharmacodynamic effects of Dopamine?
- D1 stimulation causes vasodilation
- Activates B1 in heart at higher doses
- Activation of presynaptic D2 suppresses norepinephrine release
- Stimulates vascular A1 AR to cause vasoconstriction
When should non-selective beta blockers be avoided?
-Respiratory symptoms and hypoglycemic episodes
What are selective beta blockers?
Metoprolol, betaxolol, acebutolol, atenolol
What are non-selective beta blockers?
Propranolol, Pindolol, Nadolol
How do CYP2C9 and VKORC1 affect warfarin?
CYP2C9: mutations in this affect Warfarin metabolism and thus they cannot clear it as fast.
VKORC1: individuals with the mutation have decreased expression of VKORC1, and are at increased risk of excessive anticoagulation
Which receptors are targets of cholinergic drugs in order to treat symptoms associated with airway restriction?
Blockade of airway mAChRs can cause bronchodilation and reduce secretion
What is the MOA for sildenafil?
Increase cGMP
What are side effects of ACE inhibitors?
metallic taste in mouth, elevated potassium levels, persistent cough
What are routes of administration of prostacyclin analogs?
Continuous intravenous or subcutaneous infusion or via an intermittent nebulizer
