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53 Cards in this Set

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from rattle snake, inhibit G-IIb-IIIa rec.
Eptifibatide (Integrilin),
Inhibit G-IIb-IIIa rec.
Eptifibatide (Integrilin)

Tirofiban (Aggrasta)
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
IV , short t1/2, inhibit G-IIb-IIIa rec.

b) humanized monclonal antibody
Tirofiban (Aggrasta)

b) abciximab
what r the SE of eptifibatide?

what does it treat?
Bleeding, Not immunogenic, thrombocytopenia


treat unstable angina & angiosplastic coronary interv.
Humanized monclonal antibody, ↓ platelets aggregation, common final path, block vWF & fibrinogen
abciximab (Reopro)
IV bolus, t1/2=30 min, very expensive, limit use, stick to platelets for 24 hrs
abciximab (Reopro)
w aspirin or warfarin to prevent RESTONOSIS
& recurrent MI
for Percutaneous angioplasty for coronary thrombosis
abciximab (Reopro)
which 2 drugs need to be use w APA or Warfarin
Abciximab & Dipyridamole (Persantine)
↑cAMP, gives hypotension

What does it treat?
Dipyridamole (Persantine)

b) w these drugs inhib. Embolization from prostetic heart valves
direct acting Adp recp. Inhibitor, no need for CYP450
Ticagrelor (Brilinta)
Adp recp. Inhibitor (act)

Which is slower, related to what ticlopidine
Ticagrelor (Brilinta)
Clopidogrel

b) Clopidogrel
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)
faster onset than clopidogrel
more potent, oral, not in USA, short t1/2
Reversible
Ticagrelor (Brilinta)
Decrease conduction velocity & increase QRS
type I (Na)
↑ 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
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
A thienopyridine prodrug via CYP450: bind irreversibly, prevent ADP from reacting to receptor

↓Neutropenia, ↓Thrombocytopenia than Ticlid
Clopidogrel (Plavix)
SE of quinidine
Cinchonism
Diarrhea
alpha blocking activity
A thienopyridine prodrug, bind irreversibly, prevent ADP from reacting to receptor
Clopidogrel (Plavix)

Ticlopidine (Ticlid)
strong anticholinergic is seen with type I, which one?
Disopyramide
prevent stroke as much as aspirin, standard treatment for future coronary stent pat.
Clopidogrel (Plavix)
Lupus (drug induced) is seen with type I, which one?
procainamide, slow acetylators
↑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)
... & ... prolong QT

Hypotension due to ganglionic blockade
NAPA & Procainamide(+++)

NAPA doesn't block Na channels

Procainamide
Pacemaker cells are affected by...

What happen there?
Type II (BB)
&
type IV (CCB)

Depolarization by Ca inward, they depress phase 4
Type II drugs, with type III effect
Sotalol
Drugs with all type effects, but which type is it?
Amiodarone
Type III
Type II antiarrythmic drug
pour son acceuil espere mon nom avant
... prolong phase 3 & the action potential, prolong QT, Torsades de Pointes
type III antiarrythmic
Torsades de Pointes is seen w
Type I
Type III
Effect of Amiodarone r
all 4 classes
anti-thyroid
reduces cell-cell coupling (MOA)
Given IV or oral for recurrent/resistant or unstable VF, VT refractory to other therapy, maintain sinus rhythm in atrial fibrillation
Amiodarone
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)
...inhibit hepatic metabolism & renal elimination of many drugs
Amiodarone
Amiodarone increase the effect of
quick war, pro d*efence (7)

verapamil, diltiazem
what decreases Amiodarone's level?
Cholestiramine & phenytoin
Must watch for Amiodarone r
liver, lungs, eyes, muscle, thyroid

pulmonary fibrosis less than 200 mg/d
LFT, CK, thyroid
Corneal microdeposits
Type IV Anti-arrhythmics.
Calcium channel Blockers
Verapamil, diltiazem, bepridil.
Bepridil has additional type III effects.
Type III Anti-arrhythmics.
Potassium channel blockers
prolong phase 3 and the action
potential). Bretylium, amiodarone, sotalol.
Amiodarone has also type I, II and IV actions.
Drugs that prolong the QT interval
Antimicrobials:
macrolides (erythromycin, chlarithromycin)
Pentamidine
Fluoroquinolones (grepafloxacin, moxifloxacin, levofloxacin)

Tricyclic antidepressants:
imipramine
desipramine
amitrypiline
doxepin

Thioridazine, mesoridazine, haloperidol, resperidone, ziprasidone, quetiapine
Cisapride
Indapamide
Drugs that inhibit potassium currents
Bretylium
Amiodarone
Sotalol
Quinidine
Procainamide
Dispyramide

antibiotics and antidepressants
New drug and treatment for CHF
Etomoxir

inhibits carnitine palmitoyl-tranferase 1 (CPT1) a key enzyme of mitochondrial fatty acid oxidation

shifts from fatty acid oxidation to glucose oxidation
Most common employed drugs to attempt RYTHYM control?


Hypokalemia is seen...
amiodaron
Sotalol
Dofetilide
quinidine

drug induced QT prolongation
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
Drug w proven effect on QT interval (IKr): Class III
antiarrhythmics
amiodarone
bretylium
ibutilide
dofetilide
Drug w proven effect on QT interval (IKr) : Class I and II (III)
anti-arrhythmics:
quinidine
procainamide
disopyramide
Sotalol
propafenone
bepridil
Drug w proven effect on QT interval: Anti-Psychotics
Chlorpromazine
Thioridazine
Mesoridazine
Risperidone
Ziprasidone
Haloperidol-Droperidol
Quetiapine
Pimozide
Drug w proven effect on QT interval: Anti-Depressants
Desipramine-imipramine
Doxepin
Fluoxetine
Paroxetine
Sertraline
Venlafaxine
Drug w proven effect on QT interval : Antibiotics
Pentamidine
Erythromycin
Clarithromycin
Levofloxacin
Gatifloxacin
Moxifloxacin
Sparfloxacin
Drug w proven effect on QT interval: Others
Cisapride
Felbamate, Fosphenytoin,
Foscarnet
Tacrolimus
Probucol
Sumatriptan, Naratriptan,
Zolmitriptan
Tizanidine
Indapamide, moexipril
Drug w proven effect on QT interval (Sum)
Class III
antiarrhythmics

Class I and II (III)
anti-arrhythmics

Anti-Psychotics

Anti-Depressants


Antibiotics
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