Pharmacology Flashcards
Ronalazine
Increase QT but prevents afib and Vtach
Nitrates
Forms NO with increase guanylate cyclase
Venodilation
Smooth muscle relaxation
Does not need intact endothelium
Cogent trial
No difference in event rates with plavix even when you add omeprazole
Plavix
Incomplete blockade of p2y12 receptor 85% inactive 98% reversibly bound to plasma Anti platelet effect 2 hours after loading dose Need to be metabolized to be active
Prasugrel
Avoid in TIA age>75
Weight <70ibs
Ticagrelor
Use only 100mg Asa
Shorter acting reversible
Don’t use in liver failure
Asthma like reaction
Abcixab
Severe thrombocytopenia
Don’t start in the ER
Only for pci use
Eptifibatide
Safe non imminogenic
Strptokinase
Highly antigenic
tPA non antigenic
Specific boy more bleeding
TNK longer half life
Dabigatran
Reversible thrombin inhibitor
Kidney
Amiodarone increase the dose by 50%
Riveroxaban
Take with food Reversible Xa Do not use in renal failure Dialysible Don't use with statins, ketoconazol
Apixaban
Use in RF
Aristotle study
Procan
Lupus
Don’t use in RF and CHF
Agranulocytosis
Disopyrimide
Works in HOCM
Can work in sinus Brady
Lidocaine
Dizziness seizures
CHF and hepatic
Flecanide
Depresses rapid upstroke of AP, slows conduction
Negative ionotropic
Donot use in ischemic heart disease
Worsens arrhythmias in 5-25%
Propafenone
Negative ionotropy Some beta blockade Worsens CHF Bronchospasm Pro arrhythmic in 5% Very effective in PVC therapy
Sotolol
Do not use in RF prolongs QT torsades
CHF
Defetolide
Class 3 prolongs repolarization Terminates afib flutter Safe in CHF and mi Torsades Keep in the hospital fir 3 days DC if QTc>500 Cyp3A4 verapamil statin dabi erythromycin
Amio
Guide lines do not ask for pfts
3-4% thyroid
Every one have corneal deposits has no significance
?optic neuritis German study think it’s coincidence
Thiazides
Ca excretion to prevent calcium stones
Increase sodi excretion followed by potassium secretion
Works on pct
Thiazides
Metolazone 10x more potent than hctz
Chlorthalidone long half life and constant effect on pct
2x more effective than thiazides
Both cause hypokalemia
Thiazides
Hupokakemia
Torsades
Can usually use in sulfa allergy
Loop diuretic
Ethacrynic acid no sulfa
Each molecule controls 4 molecules of water
Butemide torsemide liver excretion
More bio available
Use if lasix fails and in right heart failure
Side effects of loop diuretics
Abnormal lips
Hyper glycemic
Ototoxic ethacrynic acid
Spiranolactone
Gyneconastia
RF
Starting dose shoukd be 50mg to be effective
Use loop or metolazone
Beta blockers mi
No iv
Highest B1 blocker
Nebivolol which also releases NO
Next is bisoprolol
Metoprolol causes vasoconstriction by switching to alpha
CHF
Do not use
Pindalol
Or acebutalol both + ISA
CHF and dibutamine
Comet study
Coreg.markedly reduces dibutamine response
Lopressor only slightly inhibitory
Coreg less well tolerated in asthma
Acei
Ccb induced edema Cough 8-20% Angio edema more in blacks Elevated Cr. Need salt and volume control Works better with diuretics RF in Hypovolemia CHF bilateral Renal stenosis
Acei cough
Bradykinin and substance p
Ace escape
Increase AT2
CCB
Effective in blacks DM elderly
Reduces stroke risk
BP lowering with NSAIDs and salt
Alpha blocker
Ortho static hypotension
Worsening of The CHF
Pregnancy
No Lipitor
Statins
Hepatic 2%
Myositis >10x 0.4%
Bile acids
Reduce the absorption but liver increase the production
Zetia
Decrease cholesterol absorption and works repeatedly
No increSe in TG
Niacin
You need shorter acting niacin
Liver need niacin free time
Pregnancy
Gemfibrozil is ok not metformin of fenofibrate
Dig CHF
Reduced hospitalization not mortality
Aha guide lines
30% cal from fat 55% from carb 15% from protein Less than 10% from sat fat Less than 300 mg cholesterol per day
Fish oil ALA Anti arrhythmic Anti thrombotic Increase NO Reduce atherosclerosis
Use post mi
