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55 Cards in this Set
- Front
- Back
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What drug classes are used for HF?
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diuretics
vasodilators + ionotropic BB |
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Name and MOA of loop diuretics in HF?
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bumetanide (Bumex)
furosemide (Lasix) torsemide (Demadex) inhibits Na/K/2Cl symporter in thick ascending Loop of Henle |
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Name and MOA of thiazide diuretics in HF?
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chlorthalidone (Hygroton)
HCTZ (Microzide) indapamide (Lozol) metolazone (Zaroxolyn) inhibits Na/Cl symporter in distal convoluted tubule |
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Name and MOA of vasopressin in HF? indication?
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tolvaptan
V2 receptor antagonist, more aquaporins expressed SIADH, hyper- & eu- volemic hypoNa |
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Correcting hypoNa can cause ________ when using tolvaptan?
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osmotic demyelination
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Name and site of action of direct vasodilators in HF?
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nitroglycerin - organic nitrate, arteries
Na nitroprusside - NO donor, arteries & veins nesiritide - recomb human brain NP, arteries & veins |
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MOA of direct vasodilators?
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1. K ch activation, Ca ch inactivation, dec intracellular Ca
2. MLC phosphatase activation, MLC dephosphorylation Both result in smooth muscle relaxation |
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MOA of digoxin
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inhibits Na/K ATPase
binds to phos alpha subunit K dephos alpha subunit |
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Main effects of digoxin?
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+ ionotropic in heart
inc vagal & dec SNS inc AV refractory period & dec AV conductance |
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What does K, Ca, and Mg do to digoxin?
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hypOk: potentiates effects as well as toxicity
hypERk: attenuates effects on heart hyperCa: increase toxicity hypOmg: increase toxicity |
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Dobutamine is preferred in what type of patients?
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systolic dysfunction and CHF
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Dobutamine is a racemic mixture that stimulates ____?
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beta1 and beta2
- enan for alpha 1 + enan partial antag for alpha 1 |
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Dopamine at low dose (<2)?
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D1 receptors in vasculature: vasodilation
D2 in nerve terminals: dec NE release renal epithelial: inc naturiuresis |
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Dopamine at intermediate dose (2-5)?
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beta receptors in heart and nerve terminals: inc cardiac contractility and NE release
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Dopamine at high dose (5-15)?
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alpha 1 in vasculature: vasoconstriction
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PDE3 inhibitor?
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milrinone (Primacor)
short term support in advanced HF |
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MOA of milrinone?
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inhibit PDE3 and stimulate beta receptors
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BB indications in HF?
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mild to moderate HF (acute)
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Furosemide dose in chronic HF?
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20-40 mg daily or BID; max single dose 160-200 mg
PO dose is 1/2 of IV dose (e.g. 40 mg IV = 20 mg PO) |
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Bumetanide dose in chronic HF?
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0.5-1.0 mg daily or BID; max single dose 4-8 mg
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Torsemide dose in chronic HF?
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10-20 mg daily; max single dose 100-200 mg
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What to do in diuretic resistance in chronic HF?
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1. change loop
2. combine w/ thiazide 3. IV bolus or continuous infusion |
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Enalapril (Vasotec) in chronic HF
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2.5-5 mg BID; target 10-20 BID
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Fosinopril (Monopril) in chronic HF?
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5-10 daily; target 40 daily
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Lisinopril (Zestril) in chronic HF?
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2.5-5 daily; target 20-40 daily
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Ramipril (Altace) in chronic HF?
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1.25-2.5 daily; target 10 daily
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BB in chronic HF:
bisoprolol (Zebeta) carvedilol (Coreg) & CR metoprolol succinate (Toprol XL) |
1.25 daily; target 10 daily
3.125 BID; target 25 BID 10 daily; target 40 daily 12.5-25 daily; target 200 daily |
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Aldosterone antag in chronic HF:
spironolactone (Aldactone) eplerenone (Inspra) |
12.5-25 daily; max 25 daily or BID
25 daily; max 50 daily |
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Initial diuretic dose in ADHF (no prior use)
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Furosemide 40 mg IV bolus
Torsemide 20 mg IV bolus Bumetanide 1 mg IV bolus |
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Initial diuretic dose in ADHF (prior use)
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F: PO -> IV x2 (x1 w/ inotrope or vasodilator)
T&B: PO -> IV x3 (x2 w/ inotrope or vasodilator) |
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Continuous diuretic dose in ADHF
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F: 5mg/h; max 20mg/h
T: 2 mg/h; max 10 mg/h B: 0.5 mg/h; max 2 mg/h |
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Which AA decrease slope of phase 4?
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BB
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Which AA elevate threshold potential?
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Na and Ca channel blockers
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Which AA elongate (increase) max diastolic potential?
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Adenosine
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Which AA increase duration of AP?
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K channel blocker
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Classification of AA drugs
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Class I: Na ch blocker
Class II: BB Class III: K ch blocker Class IV: Ca ch blocker |
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Class I AA properties
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bind to open or closed, not resting
Ib: fast recovery - fast HR Ic: slow recovery - all HR Ia: intermediate |
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Potency of Class I AA
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Ic > Ia > Ib
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Class I AA drug names
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Ic: flecanide, propafenone
Ia: disopyramide (quinidine, procainamide) Ib: lidocaine, mexiletine |
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Class II AA drug names
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esmolol, metoprolol
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Class III drug names
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amiodarone, dronedarone, dofetilide, sotalol, ibutilide
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Class IV drug names
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verapamil, diltiazem
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Flecanide and propafenone is metabolized by?
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2D6
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Propafenone is a racemate that also has what effects?
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BB
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Disopyramide has vagal inhibition and has ____ effects. Metabolized by?
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anticholinergic
3A4 |
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T/F. Lidocaine is useful for atrial arrhythmias.
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False - fast recovery is not useful
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Lidocaine metabolized by? Use in caution in which patients?
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3A4
liver impairment, HF, and AV conduction deficit |
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Which Ib drug has the least 1st pass metabolism and is given PO?
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mexiletine (Mexitil)
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When this AA med is taken with food it has less ADRs
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mexiletine (Mexitil)
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Esmolol is mainly eliminated by? t 1/2?
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renal
9 min |
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ADRs of amiodarone
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pulmonary fibrosis, QT prolongation
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Which Class III AA prolongs QT but doesn't affect PR & QRS?
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dofetilide (Tikosyn)
ibutilide (Corvert) |
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dofetilide is CI with what drugs?
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verap, cimetidine, trimethoprim, ketoconazole, HCTZ
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Sotalol used in caution with?
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HF, renal impairment
hypoK, hypoMg monitor ECG closely |
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Adenosine receptors
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A1: Gi, heart
A2: Gs, endothelial and smooth muscle cells |
