Week 3 Drugs Flashcards
Fenoldopam
Diuretic- DA1 agonist
Dopamine
Diuretic_ Atrial Natriuretic Peptide (ANP)
:^RBF, reduce FF–> ^ Na and water excretion
(X) ^RBF during shock
Atriopeptin
Diuretic_ Atrial Natriuretic Peptide (ANP)
:^RBF, reduce FF–> ^ Na and water excretion
(X) ^RBF during shock
Mannitol
Diuretic _Osmotic (IV)
^ excretion of Na, K, Cl
(X) IV prophylaxis of acute renal failure, severe edema, glaucoma
(-) volume expansion of intravascular fluid volume
Acetazolamide
Diuretic---/Carbonic Anhydrase ^ urine pH ^ excretion of Na, K, HCO3 (reduced excr of Cl) (X) glaucoma- reduce aq humor - reduce drug toxicity (acidic) -acute altitude sickness (-) metabolic acidosis (loss of HCO3)
Furosemide
Diuretic_ Loop/High ceiling ---/ Na/K/2Cl symport ^RBF and GFR ^ excretion of Na, K, Cl, Ca (X) rapid/short duration diuresis - edema due to caridac, hepatic, renal disease - acute pulmonary edema -severe HTN episode (-) hypo-kalemia/uricemia/glycemia -ototoxicity, volume depletion
Bumetanide
Diuretic_ Loop/High ceiling ---/ Na/K/2Cl symport ^RBF and GFR ^ excretion of Na, K, Cl, Ca (X) rapid/short duration diuresis - edema due to caridac, hepatic, renal disease - acute pulmonary edema -severe HTN episode (-) hypo-kalemia/uricemia/glycemia -ototoxicity, volume depletion
Ethacrynic Acid
Diuretic_ Loop/High ceiling ---/ Na/K/2Cl symport ^RBF and GFR ^ excretion of Na, K, Cl, Ca (X) rapid/short duration diuresis - edema due to caridac, hepatic, renal disease - acute pulmonary edema -severe HTN episode (-) hypo-kalemia/uricemia/glycemia -ototoxicity, volume depletion
Chlorothiazide
Diuretic_ Thiazide ---/ Na/Cl Symporter reduce GFR hypertonic urine ^ excretion of Na, Cl, K (X) rapid and LONG term diuresis, edema, HTN, Hypercalciuria (-) HYPO kalemia, uricemia, glycemia (O) renal failure
Hydrochlorothiazide
Diuretic_ Thiazide ---/ Na/Cl Symporter reduce GFR hypertonic urine ^ excretion of Na, Cl, K (X) rapid and LONG term diuresis, edema, HTN, Hypercalciuria (-) HYPO kalemia, uricemia, glycemia (O) renal failure
Metolazone
Diuretic_ Thiazide ---/ Na/Cl Symporter reduce GFR hypertonic urine ^ excretion of Na, Cl, K (X) rapid and LONG term diuresis, edema, HTN, Hypercalciuria (-) HYPO kalemia, uricemia, glycemia (O) renal failure
Spironolactone
Diuretic_ K sparing - DISTAL tube--/ aldosterone ^ excr of Na, K excr reduced (X) HTN, edema, 1o aldosteronism (-) HYPERkalemia - gynecomastia
Eplerenone
Diuretic_ K sparing - DISTAL tube--/ aldosterone ^ excr of Na, K excr reduced (X) HTN, edema, 1o aldosteronism (-) HYPERkalemia - gynecomastia
Triamterene
Diuretic_ Na channel inhib ^ urine volume ^Na excr, reduced K excr (X) + thiazide diruetic to reduce K loss , edema, HTn (-) HYPERkalemia azotemia
Amiloride
Diuretic_ Na channel inhib ^ urine volume ^Na excr, reduced K excr (X) + thiazide diruetic to reduce K loss , edema, HTn (-) HYPERkalemia azotemia
Tissue Plasminogen Activator (tPA)
Thrombolytic (Alteplase) --->+ plasminogen *rapid LIVER elim (IV) (-) hemorrhage (X) manage ST-elevation myocardial infarction (STEMI)- lysis of thrombi in coronary A. - acute ischemic stroke -acute pulmonary embolism (o) active bleeding, surgery, GI bleed, known hemorrhagic disorder, HTN, Pregnancy
Alteplase
Thrombolytic (tPA) --->+ plasminogen *rapid LIVER elim (IV) (-) hemorrhage (X) manage ST-elevation myocardial infarction (STEMI)- lysis of thrombi in coronary A. - acute ischemic stroke -acute pulmonary embolism (o) active bleeding, surgery, GI bleed, known hemorrhagic disorder, HTN, Pregnancy
Aminocaproic Acid
PRO-Coagulation ---/ fibrinolysis \:bind Lys of plasminogen---/ fibrin binding (X) reverse excessive brkdown of fibrin -reduce hemorrhage w surgery -UTI bleeding (concent in urine) -hemophilia A and B
Heparin
UFH- Anti-Coagulant
NEG charge sulfated polysaccharides
^ rate of thrombin>antithrombin--/ coagulation factors
-LIVER clearance
-IV admin= *immediate effect
(X) venous thromboembolism
(X) prophylactic to prevent^
(X) cardiopulmonary bypass
(-) Bleeding
thrombocytopenia
(O) recent surgery, active bleeding, HTNLow Molecular Weight Heparins (LMWH)
- Enoxaprin
- Dalteparin
–/ Factor Xa
Enoxaparin
LMWH- Anti-Coagulant ^ antithrombin---/ Factor Xa KIDNEY clearance IV delivery (-) Bleeding, thrombocytopenia (o) renal impairment, active bleeding, surgery, HTN (X) DVT, angina and MI, hip replacement
Dalteparin
LMWH- Anti-Coagulant ^ antithrombin---/ Factor Xa KIDNEY clearance IV delivery (-) Bleeding, thrombocytopenia (o) renal impairment, active bleeding, surgery, HTN (X) DVT, angina and MI, hip replacement
Lepirudin
Direct Thrombin Inhibitor
-bind catalytic site and exosite 1 of thrombin
-KIDNEY, 1.3 hr
(-) bleeding
(o) active bleed, surgery, HTN, Renal disease
(X) alt to heparin: coronary angioplasty or cardiopulmonary bypass
Bivalirudin
Direct Thrombin Inhibitor
-bind catalytic site with Phe-Pro-Arg_Pro, exosite 1 with 2nd chain
-KIDNEY, 25min
(-) bleeding
(o) active bleed, surgery, HTN, Renal disease
(X) alt to heparin: coronary angioplasty or cardiopulmonary bypass
Fondaparinux
Direct Factor Xa Inhibitor
KIDNEY, 17hr
(-) bleeding, hemorrhage
(O) active bleed, surgery, HTN, renal impairment
(X) prophylaxis of DVT w surgery
acute PE
acute DVT wo PE
sub for pt with heparin-induced-thrombocytopenia (HIT)Protamin Sulfate
Heparin Antagonist
(+) POS charge–/ heparin
(-) anaphylactic reaction with bradycardia, vasodilation, hypotension, pulmonary HTN
(X) reverse heparin following cardiopulmonary bypass
Warfarin
ORAL Anti-coagulant antagonist of Vit K ---/ VKORC1===/ activation of clotting factors (trap VitK in epoxide form)(LIVER) -delayed onset (T1/2 of factors) (-) bleeding - CYP2C9 polymorph (*2/*3= poor metab) -VKORC1 variation -teratogenic -purple toe syndrome (><) drug intxns (O) Liver, kidney disease, vitK defic (X)long term thomboembolitic disease -prophylaxis of atrial fib, prothetic heart valve, dilated cardiomyopathy
Dabigatran
NOAC(Novel Oral Anti-coagulant)
bind thrombin (free and fibrin-bound) —/ thrombin effects
(><) Pgp exported
KIDNEY elimn
(X) post-op thromboprophylaxis
-prophyl- stroke and systemic embolism in non-valvular atrial fib
Rivaroxaban
NOAC(Novel Oral Anti-coagulant)
Direct Factor Xa inhibitor—/ conversion of prothrombin>thrombin
KIDNEY (1/3) and LIVER (2/3) elim
Pgp efflux
(-) bleeding
(X) reduce risk of stroke and systemic embolism
-prophyl of DVT w surgery
Aspirin
Anti-Platelet IRREVERSIBLE---/ COX1 (-) GI sxs (X) acute/prophyl MI - acute/prophyl ischemic stroke -unstable angina -pre-eclampsia prophyl
Dipyridamole
Anti-Platelet
—/PDE= ^cAMP=vasoDILATOR
(-) headache, GI upset, dizziness
(X) prevent thromboemboli in prosthetic heart valve
Ticlopidine
Anti-Platelet (IRREVERSIBLE)
—/ADP bind to P2yR
prodrug> CYP2C19> active*
(-) bleeding, dyspnea, neutropenia
Clopidogrel
Anti-Platelet (IRREVERSIBLE) ---/ADP bind to P2yR prodrug> CYP2C19> active* (-) bleeding, dyspnea, neutropenia (O) CYP2C19 inhibitors (proton-pump inhib) (X) unstable angina, NSTEMI
Prasugrel
Anti-Platelet (IRREVERSIBLE) ---/ADP bind to P2yR prodrug> CYP> active* (-) bleeding, dyspnea, neutropenia (X) reduce thrombotic CV with NSTEMI, STEMI, PCI
Ticagrelor
Anti-Platelet (reversible) ---/ADP bind to P2yR prodrug> active* (-) bleeding, dyspnea, neutropenia (X) +aspirin prevent thrombotic events with UA, NSTEMI, STEMI, PCI, coronary artery bypass graft
Abciximab
Glycoprotein IIb/IIIa-R blocker
Fab (monoclonal Ab) bind FbIIb/IIIa to prevent fibrinogen binding and cross-link of platelets
NON-competitive
(-) bleeding, thrombocytopenia, HoTN, bradycardia
(X) prevent thrombosis w coronary interventions
Eptifibatide
Glycoprotein IIb/IIIa-R blocker ---/ fibrinogen cross-linking COMPETITIVE --/ GPIIa/IIIa-R (-) bleeding, thrombocytopenia, HoTN, Bradycardia (O) renal dysfunction (X) unstable angina w MI
