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53 Cards in this Set
- Front
- Back
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from rattle snake, inhibit G-IIb-IIIa rec.
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Eptifibatide (Integrilin),
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Inhibit G-IIb-IIIa rec.
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Eptifibatide (Integrilin)
Tirofiban (Aggrasta) |
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Which is good to treat unstable angina?
How is monitoring of rattle-snake derivating drug compared to abciximab |
Eptifibatide (Integrilin)
Ticlopidine b) less than abciximab |
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IV , short t1/2, inhibit G-IIb-IIIa rec.
b) humanized monclonal antibody |
Tirofiban (Aggrasta)
b) abciximab |
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what r the SE of eptifibatide?
what does it treat? |
Bleeding, Not immunogenic, thrombocytopenia
treat unstable angina & angiosplastic coronary interv. |
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Humanized monclonal antibody, ↓ platelets aggregation, common final path, block vWF & fibrinogen
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abciximab (Reopro)
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IV bolus, t1/2=30 min, very expensive, limit use, stick to platelets for 24 hrs
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abciximab (Reopro)
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w aspirin or warfarin to prevent RESTONOSIS
& recurrent MI for Percutaneous angioplasty for coronary thrombosis |
abciximab (Reopro)
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which 2 drugs need to be use w APA or Warfarin
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Abciximab & Dipyridamole (Persantine)
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↑cAMP, gives hypotension
What does it treat? |
Dipyridamole (Persantine)
b) w these drugs inhib. Embolization from prostetic heart valves |
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direct acting Adp recp. Inhibitor, no need for CYP450
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Ticagrelor (Brilinta)
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Adp recp. Inhibitor (act)
Which is slower, related to what ticlopidine |
Ticagrelor (Brilinta)
Clopidogrel b) Clopidogrel |
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T or F
All drug with type II activity induce severe arrythmia |
F
All drug with type "III" activity induce severe arrythmia (K relaxes heart) |
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faster onset than clopidogrel
more potent, oral, not in USA, short t1/2 Reversible |
Ticagrelor (Brilinta)
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Decrease conduction velocity & increase QRS
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type I (Na)
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↑ of dyspnea, bleed, ventricular pauses on Holter monitor
↑ uric acid, ↑ creatine more... less variability in response when monitored |
Ticagrelor (Brilinta)
than clopidogrel bcoz ticagrelor's similarity w Adenosine |
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similarities of type I
cptmim |
Correct K levels
Torsade de pointes Prolong QRS (excess) Monitorin: ECG, WBC, platelets caution if contractility depress by disease or drug Immunological SE MOA & clinical indications |
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A thienopyridine prodrug via CYP450: bind irreversibly, prevent ADP from reacting to receptor
↓Neutropenia, ↓Thrombocytopenia than Ticlid |
Clopidogrel (Plavix)
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SE of quinidine
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Cinchonism
Diarrhea alpha blocking activity |
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A thienopyridine prodrug, bind irreversibly, prevent ADP from reacting to receptor
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Clopidogrel (Plavix)
Ticlopidine (Ticlid) |
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strong anticholinergic is seen with type I, which one?
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Disopyramide
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prevent stroke as much as aspirin, standard treatment for future coronary stent pat.
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Clopidogrel (Plavix)
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Lupus (drug induced) is seen with type I, which one?
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procainamide, slow acetylators
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↑CV events in poor CYP2C19, black box warning for prodrug
b)less toxic than ticlopidine, Genetic test in this gene is needed for polymorhis in WBA |
Clopidogrel (Plavix)
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... & ... prolong QT
Hypotension due to ganglionic blockade |
NAPA & Procainamide(+++)
NAPA doesn't block Na channels Procainamide |
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Pacemaker cells are affected by...
What happen there? |
Type II (BB)
& type IV (CCB) Depolarization by Ca inward, they depress phase 4 |
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Type II drugs, with type III effect
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Sotalol
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Drugs with all type effects, but which type is it?
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Amiodarone
Type III |
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Type II antiarrythmic drug
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pour son acceuil espere mon nom avant
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... prolong phase 3 & the action potential, prolong QT, Torsades de Pointes
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type III antiarrythmic
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Torsades de Pointes is seen w
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Type I
Type III |
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Effect of Amiodarone r
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all 4 classes
anti-thyroid reduces cell-cell coupling (MOA) |
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Given IV or oral for recurrent/resistant or unstable VF, VT refractory to other therapy, maintain sinus rhythm in atrial fibrillation
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Amiodarone
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T or F
Amiodarone is ... a) highly hydrophobic b) accumulates and elimintaes quickly c)may not require loading regimen d)theurapeutic level: 0.5-2 mg/ml e)metabolized by CYP3AC to des-ethyl-amiodarone, (inactive metabolite) |
a)true
b)F, slowly 4 both c)F, may require loading regimen d)F, ug/ml e)F, metabolized by "CYP3A4" to des-ethyl-amiodarone, ("active") metabolite) |
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...inhibit hepatic metabolism & renal elimination of many drugs
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Amiodarone
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Amiodarone increase the effect of
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quick war, pro d*efence (7)
verapamil, diltiazem |
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what decreases Amiodarone's level?
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Cholestiramine & phenytoin
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Must watch for Amiodarone r
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liver, lungs, eyes, muscle, thyroid
pulmonary fibrosis less than 200 mg/d LFT, CK, thyroid Corneal microdeposits |
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Type IV Anti-arrhythmics.
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Calcium channel Blockers
Verapamil, diltiazem, bepridil. Bepridil has additional type III effects. |
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Type III Anti-arrhythmics.
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Potassium channel blockers
prolong phase 3 and the action potential). Bretylium, amiodarone, sotalol. Amiodarone has also type I, II and IV actions. |
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Drugs that prolong the QT interval
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Antimicrobials:
macrolides (erythromycin, chlarithromycin) Pentamidine Fluoroquinolones (grepafloxacin, moxifloxacin, levofloxacin) Tricyclic antidepressants: imipramine desipramine amitrypiline doxepin Thioridazine, mesoridazine, haloperidol, resperidone, ziprasidone, quetiapine Cisapride Indapamide |
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Drugs that inhibit potassium currents
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Bretylium
Amiodarone Sotalol Quinidine Procainamide Dispyramide antibiotics and antidepressants |
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New drug and treatment for CHF
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Etomoxir
inhibits carnitine palmitoyl-tranferase 1 (CPT1) a key enzyme of mitochondrial fatty acid oxidation shifts from fatty acid oxidation to glucose oxidation |
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Most common employed drugs to attempt RYTHYM control?
Hypokalemia is seen... |
amiodaron
Sotalol Dofetilide quinidine drug induced QT prolongation |
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most antiarrhythmis drugs have what effect?
examples |
negative inotropic effects which worse HF
quinidine procainamide propafenone d-sotalol exception: Amidoranone- class III drug but it has a sympatholytic action |
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Drug w proven effect on QT interval (IKr): Class III
antiarrhythmics |
amiodarone
bretylium ibutilide dofetilide |
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Drug w proven effect on QT interval (IKr) : Class I and II (III)
anti-arrhythmics: |
quinidine
procainamide disopyramide Sotalol propafenone bepridil |
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Drug w proven effect on QT interval: Anti-Psychotics
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Chlorpromazine
Thioridazine Mesoridazine Risperidone Ziprasidone Haloperidol-Droperidol Quetiapine Pimozide |
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Drug w proven effect on QT interval: Anti-Depressants
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Desipramine-imipramine
Doxepin Fluoxetine Paroxetine Sertraline Venlafaxine |
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Drug w proven effect on QT interval : Antibiotics
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Pentamidine
Erythromycin Clarithromycin Levofloxacin Gatifloxacin Moxifloxacin Sparfloxacin |
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Drug w proven effect on QT interval: Others
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Cisapride
Felbamate, Fosphenytoin, Foscarnet Tacrolimus Probucol Sumatriptan, Naratriptan, Zolmitriptan Tizanidine Indapamide, moexipril |
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Drug w proven effect on QT interval (Sum)
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Class III
antiarrhythmics Class I and II (III) anti-arrhythmics Anti-Psychotics Anti-Depressants Antibiotics |
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a)Most common arrythmias
b) Amiodarone is combined w... c)Which arrythmia is most commom in pt w HF d) which drugs r AV blockers? |
a)Atrial fibrillation
b)warfarin c)atrial fibrillation d)(CCB) digoxin, diltiazem, verapamil |
