Pharmacology Flashcards
Antiarrhythmics (AA) causing increased QT interval
quinidine and procainamide (IA) AND AND disopyramide, amiodarone, sotalol, dofetilide
Antibiotics causing increased QT interval
azithromycin, clarithromycin, erythromycin (macrolides) AND trimethoprim-sulfamethoxazole, ketoconazole AND pentamidine, some flouroquinolones, mefloquine
Amiodarone (Cordarone), bretylium, ibutilide and sotalol (Betapace®) are class… antiarrhythmic drugs.
class III antiarrhythmic
Cough headache, ice-pick headache syndrome, chronic paroxysmal hemicrania and other syndromes such as effort migraine, coital headache, and hemicrania continua respond to …
indomethacin
Macrolides are…
ACE: azithromycin, clarithromycin, erythromycin
… and … are diuretics that competitively inhibit the mineralocorticoid (aldosterone) receptor.
Spironolactone / eplerenone
Pleuresy is often the presenting symptom in … induced by procainamide, hydralazine, minocycline, diltiazem and other Rx.
SLE
Lidocaine, tocainide are class… antiarrhythmic drugs.
IB
The … drugs act by modulating or closing the sodium channels, thereby inhibiting phase 0 depolarization.
class I antiarrhythmic
Drugs causing metabolic coma are …, … and ….
benzodiazepines AND barbiturates AND opioids
Flecainide (Tambocor™), propafenone (Rythmol) are class… antiarrhythmic drugs.
IC
… block the potassium channels, thereby prolonging repolarization and the duration of the action potential and the refractory period, manifested on the surface ECG by prolongation of the QT interval.
Class III antiarrhythmics
As a general rule, any herbs starting with the letter “G” should raise concern about possible …
Bleeding disorders
… root or extract taken in high doses may interact with antihypertensives and cause hypertension by allowing endogenous cortisol to act as a mineralocorticoid.
Licorice
Intravenous … is the single most effective intervention for the management of TCA cardiovascular toxicity, because it can reverse QRS prolongation, ventricular arrhythmias, and hypotension.
sodium bicarbonate
There are multiple, mostly nonspecific manifestations of …: fatigue, blurred vision, disturbed color perception, anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium, and occasionally hallucinations
digitalis toxicity
Concomitant ingestion of … (food) and certain dihydropyridine calcium channel blockers may elevate the plasma concentration of the latter, possibly leading to hypotension
grapefruit juice
… used as a sedative, it can lead to dermatitis, hallucinations, SOB, liver toxicity.
Kava-kava
… may be the most frequent adverse reaction to herbal remedies (Jin Bu Huan, Ma-Huang, germander, valerian, mistletoe, skullcap, chaparral leaf, comfrey), and herbal teas containing toxic alkaloids, pennyroyal oil, and kava.
Hepatotoxicity
Hypertension, hypotension, tachycardia, ventricular arrhythmias, cardiac arrest are all side effects of this antidote …
Naloxone
The presenting signs of a … overdose include cardiac arrhythmias, hypotension, and anticholinergic signs (hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, and sinus tachycardia)
TCA
Toxic levels of… (eg, tricyclic antidepressants, antipsychotic medication, benzodiazepines) can result in CNS excitation, which may lead to confusion, delirium, hallucinations, and seizures. Some patients develop hyperpyrexia, cardiac arrhythmias, coma, a
anticholinergic agents
Diuretics, especially HCTZ, are notorius for inducing or precipitating… (GI condition).
constipation
… has shown some efficacy in patients with nonorganic erectile dysfunction, but not in one with organic causes.
Yohimbine
… (antimalarial drug) is contraindicated in patients with cardiac conduction disease.
Mefloquine
A rise in INR at 48 hours after the first dose implies … (condition), due to either other drugs or a problem with the cytochrome P-450 system.
high sensitivity to warfarin
Regular … Rx is an absolute contraindication to sildenafil use because of hypotensive effect potentiation.
nitrate
… complications are significantly increased in patients who are receiving activated protein C (dotrecogin alfa).
Bleeding
ACEI and ARBs should be discontinued in the … trimesters because of fetal complications.
2nd and 3rd
… are the most potent anti-retroviral drugs and most commonly studied for long-term follow-up when taken together with two NRTI.
Protease inhibitors (PI)
ABx … (side effect) should not be used in patients receiving class IA or III antiarrhythmic agents.
prolonging the QTc interval (fluoroqui, macro)
The 8 mg dexamethasone suppression test differentiates between pituitary and ectopic ACTH production, in the latter cortisol is…
not suppressed.
After large dose steroids, patients should receive stress doses steroids for… (duration)
one year.
… (2 oral hypoglycemic drugs) may cause fluid retention and weight gain and are contraindicated in severe CHF patients.
Pioglitazone (Actos) and Rosiglitazone (Avandia)
Insulin can not be combined with Pioglitazone (Actos) and Rosiglitazone (Avandia) due to…
increased risk for fluid retention with CHF.
Beta-blockers selectivity (or cardioselectivity) refers to the ability of a drug to preferentially block the…
beta-1 receptors.
BP that contraindicates for t-PA use is…
SBP>185 or DBP>110.
Advanced age is… in t-PA administration for ischemic stroke.
not a contraindication
The relatively cardioselective agents are:
atenolol or metoprolol.
Nonselective beta blockers can cause worsening of symptoms of severe peripheral vascular disease or Raynaud’s phenomenon but usually not in milder disease, with mild to moderate intermittent claudication. … are probably preferable in such patients.
Cardioselective beta blockers
The prototype nonselective beta-blocker is…
Propranolol
Toxic myopathy can be caused by… (class drugs).
statins
ABx known to cause… are: Bactrim, rifampicin, vancomycin, cephalotin and linezolid.
thrombocytopenia
Heparin, quinidine, quinine and valproic acid can all cause… (blood dyscrasia).
thrombocytopenia.
Adding warfarin to ASA and clopidogrel combination increases the risk of bleeding … times.
5
In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered in doses of …micrograms.
10
In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered every …
minute.
In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered in a concentration of …
1:10,000.
These drugs can modestly lower Lp(a) levels: …
niacin and fibric acids.
Platelet transfusion cannot be used for 2b3a reversal in drugs with high drug : receptor ratio such as …
eptifibatide (Integrilin) and tirofiban (Aggrastat). (100:1)
Platelet transfusion can be used for 2b3a reversal in drugs with low drug : receptor ratio such as …
abciximab. (1.5:1), despite being irreversible.
Metformin-induced lactic acidosis is fatal in … % of the cases.
50
Among paclitaxel and sirolimus, only … has an anti-inflammatory effect.
sirolimus
… high affinity for the beta-2 adrenergic receptor causes vasodilation and a decrease in MAP, therefore its utility in hypotensive patients is limited to situations in which hypotension results from bradycardia.
Isoproterenol’s
… is primarily an inotropic and chronotropic agent rather than a vasopressor. It acts upon beta-1 adrenergic receptors and, unlike dobutamine, has a prominent chronotropic effect.
Isoproterenol (Isuprel®)
In patients during the initial management of AMI who have a contraindication to…, coronary angiography is class IIa indication when performed in a timely fashion by individuals skilled in the procedure and supported by experienced personnel in an appropri
fibrinolytic therapy
Lidocaine has this neurological side-effect…
seizures.
The antianginal therapy of choice in patients with HTN is… (2 classes).
beta-blockers and nondihydropyridines (verapamil and diltiazem)
The short-acting dihydropyridine is…
nifedipine.
The CAPTURE trial showed benefit in using… in patients with refractory unstable angina in need for intervention only in those with elevated troponin values.
abciximab (Reopro)
The… are potent vasodilators (type of CC blockers) that have little or no negative effect upon cardiac contractility or conduction.
dihydropyridines
The therapy for variant angina consists of… and has excellent response.
nitrates and calcium blockers
The three coronary vasodilator compounds used in humans to achieve maximal arteriolar dilatation are…
dipyridamole, papaverine, and adenosine.
The most common side effects of calcium blockers are…
facial flushing and HA.
… are contraindicated in patients with PVD and resting leg pain, but can be used in intermittent claudication.
Beta blockers
The following calcium blockers are contraindicated in stable angina patients with… (valvulopathy): nifedipine (Adalat® CC; Nifedical™ XL; Procardia®; Procardia XL®), amlodipine (Norvasc®), nisoldopine (Sular®) and felodipine (Plendil®).
AS
The longer-acting dihydropyridines with… depressant activity are felodipine, isradipine, nicardipine, nifedipine, and nisoldopine.
little cardiac
The antianginal therapy of choice in patients with bradycardia and HAVB are… (2 classes).
long acting dihydropyridines (felodipine, isradipine, nicardipine, nifedipine, and nisoldipine) and long acting nitrates
Individuals with… should not be given Viagra as there is always a chance of receiving nitrates in the ER/hospital setting.
chronic stable angina
DIG trial showed digitalis reduced the re-admissions to the hospital for worsening CHF by… %, with the greatest benefit in patients with more severe symptoms and decreased EF.
28
Concomitant quinidine, amiodarone, verapamil or propafenone administration with… (antiarrhythmic) requires a decrease of 50% in its dose.
digoxin
… (drug, dose) was preferable for secondary prevention after stroke or TIA in patients with intracranial arterial stenoses in a study of 569 patients.
Aspirin (650 mg twice daily)
Doxorubicin therapy should not be initiated in patients who have a baseline EF…
<30%.
… ’s predominant effect is vasoconstrictor with little change in cardiac output.
Norepinephrine
The antidote for dipyridamole (Persantine) is…
IV aminophylline.
…, a selective alpha1-adrenergic agonist may be a good choice in shock when there is an increased risk for tachyarrhythmias.
Phenylephrine (Neosynephrine)
The immediate two meds used in acute aortic dissection to reduce the arterial pressure are…
nitroprusside and propranolol/labetalol.
Laboratory monitoring of… (antithrombotic) is recommended in renal insufficiency, morbid obesity, and pregnancy.
LMWH (e.g. Lovenox)
Patients should avoid concurrent use of… (ABx) and CYP3A inhibitors (e.g., diltiazem, verapamil) due to increased risk for SCD (sudden cardiac death).
erythromycin
Monitoring LMWH (Lovenox) is done by measuring… at 3-4 hours after an injection.
peak anti-Xa levels
Quinidine causes a twofold increase in… levels due to decrease renal elimination and displacement from tissue-binding sites.
digoxin
When methyldopa or a beta-blocker is ineffective in controlling BP during pregnancy,… is largely used.
nifedipine
Quinidine sulfate has these ECG side-effects:
prolongs QRS and QTc.
Antiarrhythmic agents with predominantly class … action (potassium channel blockers) are the most effective antiarrhythmic therapy for SV and ventricular tachyarrhythmias.
III
If overt hypothyroidism occurs with amiodarone therapy, amiodarone… and thyroid hormone replacement started.
can be continued
Agents with class… antiarrhythmic effects (calcium channel blockers) are useful for reentry rhythms involving the AVN and for slowing ventricular response to AF/Flut.
IV
Large doses of quinidine can cause…: blurred vision, tinnitus, hearing loss, visual disturbances, HA, confusion, delirium and psychosis.
chinchonism
If overt hyperthyroidism occurs with amiodarone therapy, amiodarone… and anti-thyroid agents started.
has to be stopped
… is the only ACEI available in IV form.
Enalaprilat
Procainamide has this troublesome reaction in some patients: … (arthralgias, fever, hepatomegaly and pleurisy).
drug-induced LES
… is not only an antiarrhythmic agent, but also a peripheral and coronary vasodilator and an effective antianginal agent.
Amiodarone
One large RCT in people already receiving diuretics and ACEIs found that… reduced the proportion of people admitted to hospital for worsening heart failure at 37 months compared with placebo, but found no significant difference between groups in mortali
digoxin
The statins cause a decrease in the atherosclerotic plaque lipids and inflammation and increase the plaque… content.
collagen
Activation of alpha-1 adrenergic receptors, located in the vascular walls, induces significant…
vasoconstriction.
… has purely alpha-adrenergic agonist activity and therefore results in vasoconstriction with minimal cardiac inotropy or chronotropy.
Phenylephrine (Neosynephrine®)
At doses of 1 to 2 mcg/kg per minute, dopamine acts predominantly on… in the renal, mesenteric, cerebral, and coronary beds, resulting in selective vasodilation.
dopamine-1 receptors
An accelerated junctional rhythm commonly is a complication of… toxicity.
digitalis
Dopamine receptors are present in the renal, splanchnic (mesenteric), coronary, and cerebral vascular beds; stimulation of these receptors leads to…
vasodilation.
At doses >10 mcg/kg per minute, the predominant effect of dopamine is to stimulate… receptors and produce vasoconstriction with an increased SVR.
alpha-adrenergic
… receptors are most common in the heart, and mediate increases in inotropy and chronotropy with minimal vasoconstriction.
Beta-1 adrenergic
Stimulation of beta-2 adrenergic receptors in blood vessels induces…
vasodilation.
Dobutamine increases… by beta-1 adrenergic receptor activation.
cardiac output (increases inotropy and chronotropy and reduces left ventricular filling pressure)
Dobutamine acts also upon beta-2 adrenergic receptors and thus…
induces vasodilation and can cause hypotension.
… acts on both alpha-1 and beta-1 adrenergic receptors, thus producing potent vasoconstriction as well as a less pronounced increase in cardiac output.
Norepinephrine (Levophed®)
At 5 to 10 mcg/kg per minute, dopamine also stimulates… receptors and increases cardiac output, predominantly by increasing stroke volume with variable effects on heart rate.
beta-1 adrenergic
Class… agents should not be used in patients with EF<35% owing to the high risk of proarrhythmia.
I - Ia (quinidine and procainamide), Ib (lidocaine), and Ic (propafenone)
… is contraindicated in patients with acute heparin-induced thrombocytopenia, at least until after the administration of danaparoid or thrombin inhibitors.
Warfarin
Warfarin does not have a fully therapeutic effect until the factor X and II levels decline in… days.
5 to 7. A prothrombin time INR of ~ 2.0 on 2 consecutive days helps ensure that factor X and II levels have had time to decrease to appropriate levels.
Because of one report indicating an increased incidence of major birth defects in newborns exposed to … during the first trimester, the use of verapamil is preferred when a calcium antagonist is indicated.
diltiazem
… (HIV drug class) therapy contraindicates the use of simvastatin (Zocor®) and alternatives as atorvastatin, and pravastatin should be entertained.
Protease inhibitors
In severe cases of aspirin toxicity with altered mental status, pulmonary edema, cerebral edema, or renal failure,… is needed.
hemodialysis
Patients who adhere to a vegan diet (no meat products) should be given… supplementation.
oral vitamin B12
One non-systematic review found that… (event) is more common in people of advanced age and low body weight, those with hypertension on admission, and those given tissue plasminogen activator rather than another thrombolytic agent.
intracranial hemorrhage
… (cholesterol drug) causes insulin resistance and may worsen hyperglycemia in patients with DM.
Nicotinic acid (Niacin)
The first line therapy (antidote) for cocaine intoxication are… (class drugs)
benzodiazepines (lorazepam IV/IM).
The most common initial symptoms of… (gas) intoxication are nausea, headache and dizziness.
carbon monoxide
The antidote for amphetamines is…
benzodiazepines.
The antidote for arsenic, mercury, gold or lead is…
BAL (dimercaprol).
The antidote for benzodiazepines is…
flumazenil.
The antidotes for beta-blockers and calcium-channel blockers are…
glucagon, calcium chloride and ventricular pacing.
The antidotes for… are blood alkalinization and alpha-agonists (Phenylephrine).
TCAs
The antidote for heparin is…
protamine sulfate.
The antidote for iron is…
deferoxamine.
… is the preferred drug to decrease pain for procedures due to its rapid onset and resolution.
Fenthanyl (Duragesic®)
… is the preferred drug to decrease anxiety for procedures due to its rapid onset and resolution.
midazolam (Versed®)
… is used to calm agitated delirium after reversible causes have been identified and treated.
Haloperidol (Antipsychotic, a butyrophenone)
The clinical clues to… are coma, hypotension, cardiac irritability and profound anion gap metabolic acidosis in the setting of adequate fluid resuscitation and oxygen administration.
cyanide intoxication
Combustion of natural fabrics (wool and silk) is known to produce…
hydrogen cyanide gas.
The therapy for cyanide intoxication is…
IV sodium thiosulfate.
… in using a MDI (metered dose inhaler) is the main cause of therapy failure.
Poor technique
Adding these drugs… to the treatment of acute COPD exacerbations has been shown to allow faster recory of FEV1, improve oxygenation and decrease the number of treatment failures.
corticosteroids
The cornerstone of therapy in sarcoidosis is daily… for 6-12 months.
corticosteroids
Bosentan is an… useful in stable NYHA III and IV patients with pulmonary hypertension.
endothelin receptor antagonist
Patients taking beta-blockers may develop refractory anaphylaxis (persistent hypotension and bradycardia) and should be treated with…
glucagon for its non-beta-inotropic effect.
In adult patients not responding to traditional therapy for shock,… (drug) should be used.
vasopressin
Cholinergic effects of… receptor stimulation produce salivation, lacrimation, diarrhea, and potentially lethal bronchorrhea or bronchospasm.
muscarinic
… is rarely associated with positive dsDNA and the complement level is usually normal, but antihistone antibodies are positive in 95% of cases.
Drug-induced lupus
… a glucose-lowering drug used commonly in patients with type 2 diabetes, may result in small amounts of weight loss.
Metformin,
Renin-angiotensin inhibitors, angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), are associated with hyperkalemia in about …% of patients
10
In older patients taking ACE inhibitors and ARBs, TMP/SMX use was associated with excess risk for sudden death — presumably from trimethoprim-induced…
hyperkalemia
In patients older than 80, …use was associated with higher odds of general pain
statin
