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511 Cards in this Set
- Front
- Back
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botulinum toxin: class
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anti-cholinergic
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carbidopa: class
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anti-adrenergic
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tyramine: class
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adrenergic
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phenylephrine: class
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alpha agonist
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methoxamine: class
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alpha agonist
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norepinephrine: class
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alpha agonist
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phenylephrine: class
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alpha agonist
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dopamine: class
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alpha agonist
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phentolamine: class
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allpha antagonist
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phenoxybenzamine: class
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allpha antagonist
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prazosin: class
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allpha antagonist
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clonidine: class
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centrally acting alpha agonist
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methyldopa: class
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centrally acting alpha agonist
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yohimbine: class
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alpha 2 antagonist
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isoproterenol: class
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beta agonist
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dobutamine: class
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beta agonist
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propranolol: class
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beta blocker
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metoprolol: class
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beta blocker
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atenolol: class
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beta blocker
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bromocriptine: class
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dopamine agonist
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ephedrine: class
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indirectly acting pheylethylamine
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phenylpropanolamine: class
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indirectly acting pheylethylamine
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pseudoephedrine: class
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indirectly acting pheylethylamine
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methacholine: class
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muscarinic agonist
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bethanechol: class
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muscarinic agonist
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pilocarpine: class
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muscarinic agonist
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atropine: class
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muscarinic antagonist
(competitive inhibitor) |
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nicotine: class
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nicotinic agonist
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insecticides: class
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cholinesterase inhibitor
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physostigmine: class
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cholinesterase inhibitor
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neostigmine: class
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cholinesterase inhibitor
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organophosphates: class
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cholinesterase inhibitor
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tubocurarine: class
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Nondepolarizing neuromuscular blocker
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succinylcholine: class
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depolarizing neuromuscular blocker
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dantrolene: class
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spasmolytic
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botulinum toxin: administration
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local injection
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tubocurarine: administration
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parenteral
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succinylcholine: administration
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parenteral
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propranolol: administration
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IV, oral (40x greater oral b/c 1st pass effect)
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esmolol: administration
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IV only
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methyldopa: administration
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IV as its ethyl ester
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phenoxybenzamine: administration
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oral
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phentolamine: administration
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IV
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Nitroglycerin: administration
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orally, sublingual, transdermal, spray to buccal mucosa, IV
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Isosorbide dinitrate: administration
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oral
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nitroprusside: administration
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IV only, with glucose water solution
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mannitol: administration
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IV
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quinidine: administration
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oral
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procainamide: administration
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IV
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lidocaine: administration
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IV
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mexiletine: administration
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oral
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tocainide: administration
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oral
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esmolol: administration
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IV
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ibutilide: administration
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IV
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inamrinone: administration
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IV
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streptokinase: administration
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IV
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t-PA: administration
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IV
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reteplase: administration
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IV, double bolus
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TNK t-PA : administration
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single bolus
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Unfractionated Heparin: administration
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never IM goddamit. IV and subq
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Lepirudin: administration
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IV
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Agatroban: administration
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IV
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Warfarin: administration
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oral, 100% absorption
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lidocaine: distribution and elimination times
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8 min dist, 108 min elim...elim t1/2 determines time to steady state and maintanence dosing
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phenoxybenzamine: time to clinical effect
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hours
|
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methyldopa: time to clinical effect
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six hours (must be metabolized)
|
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Nitroglycerin: time to clinical effect
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minutes
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Isosorbide dinitrate: time to clinical effect
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30-90 min
|
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Isosorbide mononitrates: time to clinical effect
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30-60 min
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Losartan: time to clinical effect
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3-4 hours
|
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amiodarone: time to clinical effect
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slow accumulation to steady state
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Ticlopidine: time to clinical effect
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delay in onset 5=10 dias
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botulinum toxin: duration/half life
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weeks/months
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phentolamine: duration/half life
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short acting
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phenoxybenzamine: duration/half life
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days
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tubocurarine: duration/half life
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60 min half life
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succinylcholine: duration/half life
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5-10 min half life
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propranolol: duration/half life
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3-6 hours
|
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esmolol: duration/half life
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9 min
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phenoxybenzamine: duration/half life
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over a day
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terazosin: duration/half life
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3-4 hours
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Nitroglycerin: duration/half life
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30 min-hrs
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Isosorbide dinitrate: duration/half life
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hrs
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Isosorbide mononitrates: duration/half life
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hrs
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nitroprusside: duration/half life
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short, minutes
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nifedipine: duration/half life
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long acting
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verapamil: duration/half life
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long acting
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diltiazem: duration/half life
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long acting
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esmolol: duration/half life
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9 min half life
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amiodarone: duration/half life
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very long, 40-60 days
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inamrinone: duration/half life
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elimination half life 2.5 hours, but can be >12 hours in CHF pts
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APSAC: duration/half life
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stupid long, yo. 60 mins
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t-PA: duration/half life
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stupid short, yo. 6 minutes
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Ticlopidine: duration/half life
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effects persist several days
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Lepirudin: duration/half life
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slower clearance than heparin, can give sub q
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digoxin: time to steady state after maintanance dosages started
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1 week
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digitoxin: time to steady state after maintanance dosages started
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1 month
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botulinum toxin: mechanism
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blocks release of Ach
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tyramine: mechanism
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displaces norepinephrine into synaptic cleft
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methyldopa: mechanism
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metabolized to alphamethylnorepinephrine, which stimulates presynaptic alpha 2 receptors
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ephedrine: mechanism
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indirectly acting adrenergic
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pseudoephedrine: mechanism
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indirectly acting adrenergic
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methacholine: mechanism
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muscarinic agonist
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bethanechol: mechanism
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muscarinic agonist
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pilocarpine: mechanism
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muscarinic agonist
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pralidoxime: mechanism
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reactivates cholinesterase
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organophosphates: mechanism
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cholinesterase inhibition
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tubocurarine: mechanism
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nondepolarizing blockade at neuromuscular jnx
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succinylcholine: mechanism
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depolarizing neuromuscular blockade
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dantrolene: mechanism
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reduces release of Ca++ from sarcoplasmic reticulum
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atenolol: mechanism
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beta 1 selective blocker
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metoprolol: mechanism
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beta 1 selective blocker
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labetalol: mechanism
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alpha 1 antagonist; beta 1 antagonist; beta 2 agonist
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labetalol RR stereoisomer: mechanism
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beta 1 antabonist and partial beta 2 agonist
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labetalol SR stereoisomer: mechanism
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alpha 1 antagonist
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carvedilol, R isomer: mechanism
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alpha 1 blocker
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carvedilol, S isomer: mechanism
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beta blocker and alpha 1 blocker
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NO dependent vasodialtors: mechanism
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activates guanylate cyclase, inc cGMP, cGMP activates protein kinase -> dilation of veins (major) and coronary vessels (minor)
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sildenafil: mechanism
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inhibits cGMP phosphpodiesterase Type V
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hydralazine: mechanism
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who the fuck knows?
|
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minoxidil: mechanism
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opens ATP sensitve K+ channel in arterial smooth muscle, dilates arteries
|
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Captopril: mechanism
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block conversion of Ang I to Ang II, block degradation of bradykinin
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mannitol: mechanism
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filtered but not resorded, osmotically inspired diuresis
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furosemide: mechanism
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inhibit contransport of Na, Cl, and K at the luminal membrane of the thick ascending limb of Henle's loop
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ethacrynic acid: mechanism
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inhibit contransport of Na, Cl, and K at the luminal membrane of the thick ascending limb of Henle's loop
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hydrochlorothiazide: mechanism
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inhibit Na transport in distal convoluted tubule (Na-Cl cotransporter)
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triamterene: mechanism
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inhibit luminal Na channel in collecting tubules
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amiloride: mechanism
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inhibit luminal Na channel in collecting tubules
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quinidine: mechanism
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block Na and K currents, alpha block and vagal inhibition
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procainamide: mechanism
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blocks Na and K channels
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sotalol: mechanism
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non selective beta blocker, K channel blocker
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ibutilide: mechanism
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K blocker, Na opener
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digitalis: mechanism
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increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
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digoxin: mechanism
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increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
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digitoxin: mechanism
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increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
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inamrinone: mechanism
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inhibits phosphodiesterase Type III (cardiac), increased cAMP -> increased intracellular Ca++
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streptokinase: mechanism
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indirect plasminogen activator...binds w/ a plaminogen molecule, complex activates 2nd molecule
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urokinase: mechanism
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direct plasminogen activator
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t-PA: mechanism
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binds to fibrin, directly activates plasminogen
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reteplase: mechanism
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binds to fibrin, directly activates plasminogen
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Aspirin: mechanism
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inhibits cyclooxygenase, thereby decreasing thromboxane A2
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Dipyridamole: mechanism
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Inhibits phosphodiesterase to increase accumulation of cAMP, blocks adenosine uptake, prevents platelet activation
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Ticlopidine: mechanism
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inhibits ADP activation, inhibit glycoprotein Iib/IIIa receptor and vonWillebrand factor
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Clopidogrel: mechanism
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inhibits ADP activation, inhibit glycoprotein Iib/IIIa receptor and vonWillebrand factor
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Abciximab: mechanism
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antibody to glycoprotein Iib/IIIa
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Unfractionated Heparin: mechanism
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inactivates coag factors, most importantly II and X
|
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Low-Molecular Weight Heparins: mechanism
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bind antithrombin-III/thrombin (little effect on PTT)
|
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Lepirudin: mechanism
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direct thrombin inactivator
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Agatroban: mechanism
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directly reversibly inhibits thrombin
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Warfarin: mechanism
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inhibits vitamin K, thusinhibits II, VII, IX, X, protein C, and protein S
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digitalis: electrophysiologic effects on His-Purkinje system
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resting potential more positive; Action Potential duration shortens; enhanced phase 4 depolarization (automaticity) at higher concentrations
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carbidopa: receptor, effect
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inhibits dopa decarboxylase (dopa to dopamine)
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phentolamine: receptor, effect
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alpha 1; competitive antagonist
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phenoxybenzamine: receptor, effect
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alpha 1; noncompetitive antagonist
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clonidine: receptor, effect
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presynaptic alpha 2 stimulation, feedback inhibition of norepinephrine
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yohimbine: receptor, effect
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blocks alpha 2 receptors in medulla, increased sympathetic outflow
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isoproterenol: receptor, effect
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stimulates beta 1 and beta 2 receptors
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dobutamine: receptor, effect
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beta 1 agonist
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propranolol: receptor, effect
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competitive inhibitor at beta 1 and beta 2
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metoprolol: receptor, effect
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selective blocker of beta 1
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atenolol: receptor, effect
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beta 1 blocker
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methacholine: receptor, effect
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muscarinic agonist
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bethanechol: receptor, effect
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muscarinic agonist
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pilocarpine: receptor, effect
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muscarinic agonist
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atropine: receptor, effect
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muscarinic antagonist
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nicotine: receptor, effect
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nicotinic agonist
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insecticides: receptor, effect
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inhibits acetylcholinesterase and pseudocholinesterase
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labetolol: receptor, effect
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beta blocker and alpha 1 blocker (more pronounced when given orally)
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carvedilol: receptor, effect
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beta blocker and alpha 1 blocker
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nifedipine: receptor, effect
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block L-type C++ channel, vascular
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verapamil: receptor, effect
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block L-type C++ channel, cardio
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diltiazem: receptor, effect
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block L-type C++ channel, cardio adn vascular
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acetazolamide: receptor, effect
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noncompetitive inhibition of carbonic anhydrase in proximal tubule, prevents reabsorption of NaHCO3, net secretion of NaHCO3 with obligatory H2O
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spironolactone: receptor, effect
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competes with aldosterone for cytosolic receptor, prevents aldosterone inspired K excretion and Na reabsorption
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amiodarone: lipophilicity
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high
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carbidopa: clinical use
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decrease peripheral dopamine production in anti-parkinsons tx
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phenylephrine: clinical use
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tx hyptension, cause mydriasis, tx nasal congestions, tx paroxysmal atrial tachycardia
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phentolamine: clinical use
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dx of pheochromocytoma, emergent tx of pheochromocytoma
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phenoxybenzamine: clinical use
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tx of pheochromocytoma
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clonidine: clinical use
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tx of hypertension
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yohimbine: clinical use
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aphrodisiac
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isoproterenol: clinical use
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tx gravid uterus, asthma
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pseudoephedrine: clinical use
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tx nasal congestion
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methacholine: clinical use
|
provoke bronchoconstriction w/ methacholine challenge
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bethanechol: clinical use
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improving gastric emptying; tx urinary retention
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pilocarpine: clinical use
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induce salivation; tx open angle glaucoma
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atropine: clinical use
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tx vasovagal syncope, decrease respiratory secretions
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physostigmine: clinical use
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tx of anticholinergic syndrome
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neostigmine: clinical use
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tx atonly of detrusor, tx myasthenia gravis, tx glaucoma
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organophosphates: clinical use
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kill one's enemies
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dantrolene: clinical use
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tx of malignant hyperthermia (releave muscle contracture)
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tx torsades de pointes
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isoproterenol
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methyldopa: clinical use
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tx htn
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clonidine: clinical use
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tx htn
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Nitroglycerin: clinical use
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angina
|
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Isosorbide dinitrate: clinical use
|
angina
|
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Isosorbide mononitrates: clinical use
|
angina
|
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sildenafil: clinical use
|
stiff penis
|
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nitroprusside: clinical use
|
acute hypertension, perioperative hypertension control, heart failure
|
|
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hydralazine: clinical use
|
hypertension (best w/ beta blocker) heart failure (combined w/ nitrates and diuretics)
|
|
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minoxidil: clinical use
|
difficult hypertension (need beta blocker and diuretic) hair growth
|
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nifedipine: clinical use
|
hypertension
|
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acetazolamide: clinical use
|
tx of glaucoma, acute mountan sickness, metabolic alkalosis
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|
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furosemide: clinical use
|
acute pulmonary edema, severe edema; hypercalcemia
|
|
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ethacrynic acid: clinical use
|
acute pulmonary edema, severe edema; hypercalcemia
|
|
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hydrochlorothiazide: clinical use
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tx of essential hypertension, nephrogenic diabetes insipidous, tx hypercalciuria
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spironolactone: clinical use
|
tx of edema of cirrhosis, K sparing used in conjunction with k wasting diuretics, counteract aldosterone escape with ACEIs and ARBs
|
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quinidine: clinical use
|
chronic oral therapy of atrial fib/flutter (and VT)
|
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procainamide: clinical use
|
supraventricular and ventricular arrhythmias
|
|
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amiodarone: clinical use
|
effective for most arrhythmias; refractory VT/VF
|
|
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ibutilide: clinical use
|
atrial flutter, less effective w/ atrial fib
|
|
|
dofetilide: clinical use
|
Atrial fib/flutter, esp patients w/ left ventric dysfunction
|
|
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digitalis: clinical use
|
relieve sx of CHF; supraventricular arrhythmias (but can block AV node completely and cause Atrial fib)
|
|
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inamrinone: clinical use
|
short term CHF support
|
|
|
e-aminocaproic acid: clinical use
|
antifibrinolytic
|
|
|
tranexamic acid: clinical use
|
antifibrinolytic
|
|
|
prazosin: Problems
|
prazosin syncope
|
|
|
methyldopa: Problems
|
high doses may stimulate peripheral alpha 2 receptors, causing hypertension
|
|
|
propranolol: Problems
|
avoid in asthmatics
|
|
|
nicotine: Problems
|
bexold jarisch reflex (bradycardia, hypotension, nausea)
|
|
|
clonidine: Problems
|
clonidine rebound if withdrawn quickly
|
|
|
prazosin: Problems
|
First dose effect: severe hypotension w/ first dose. Tachyphylaxis
|
|
|
hydralazine: Problems
|
drug induced lupus erythmatosis, ANA positive, anti-histone antibodies
|
|
|
minoxidil: Problems
|
hair growth (not always problem), bigger heart if no beta blocker
|
|
|
propranolol: crosses CNS barrier?
|
yes
|
|
|
metoprolol: crosses CNS barrier?
|
yes
|
|
|
atenolol: crosses CNS barrier?
|
no
|
|
|
physostigmine: crosses CNS barrier?
|
yes
|
|
|
neostigmine: crosses CNS barrier?
|
no, charged quaternary amine
|
|
|
tubocurarine: crosses CNS barrier?
|
loss of ventilation, histamine release, ANS effects
|
|
|
succinylcholine: crosses CNS barrier?
|
loss of ventilation, histamine release, ANS effects
|
|
|
propranolol: crosses CNS barrier?
|
oh yeah
|
|
|
atropine: adverse effects
|
constipation, xerostomia, hypohidrosis, mydriasis, urinary retention, glaucoma, decreased lacrimation, tachycardia, decreased respiratory secretions
|
|
|
organophosphates: adverse effects
|
Salivation, Lacrimation, Urination, Defecation, GI, Emesis....departure of soul
|
|
|
methyldopa: adverse effects
|
sedation, depression; hepatic toxicity; hemolytic anemia w/ positvie coomb's test
|
|
|
clonidine: adverse effects
|
Clonidine rebound when discontinued; sedation, depression; dry mouth; lost libido
|
|
|
phenoxybenzamine: adverse effects
|
hypotension, can be corrected with volume expansion
|
|
|
phentolamine: adverse effects
|
hypotension can tx with volume expansion
|
|
|
DILATORS: adverse effects
|
dizziness, headache
|
|
|
hydralazine: adverse effects
|
Lupus, Na retention, ischemia (coronary steal), enlarge heart if no beta blocker
|
|
|
furosemide: adverse effects
|
hpokalemia, los of Ca++ and Mg++
|
|
|
ethacrynic acid: adverse effects
|
hpokalemia, los of Ca++ and Mg++
|
|
|
spironolactone: adverse effects
|
hyperkalemia, gynecomastia--steroid cross talk
|
|
|
quinidine: adverse effects
|
diarrhea/gi intolerance 50%, Torsade de Pointes
|
|
|
N-acetylprocainamide: adverse effects
|
Lupus syndrome, 0.2% marrow aplasia
|
|
|
lidocaine: adverse effects
|
CNS toxicity
|
|
|
mexiletine: adverse effects
|
CNS toxicity
|
|
|
tocainide: adverse effects
|
CNS toxicity
|
|
|
amiodarone: adverse effects
|
multiple toxicities, eye, lungs, skin, thyroid
|
|
|
bretylium: adverse effects
|
biphasic autonomic response: hypertension, then hypotension--causes side effects
|
|
|
ibutilide: adverse effects
|
Torsades de Pointes
|
|
|
dofetilide: adverse effects
|
Torsades de Pointes, important dose adjustment if renal insufficiency
|
|
|
digitalis: adverse effects
|
DADs, arrythmias
|
|
|
streptokinase: adverse effects
|
pt might have developed antibody from previous exposure
|
|
|
Ticlopidine: adverse effects
|
neutropenia
|
|
|
Clopidogrel: adverse effects
|
neutropenia
|
|
|
Unfractionated Heparin: adverse effects
|
allergic toxicity, bleeding (use protamine), heparin induced thrombocytopenia, immune mediated thrombotic compliactions (use direct antithrombins)
|
|
|
Warfarin: adverse effects
|
paradoxical thrombosis from inhibition of protein C and S
|
|
|
neostigmine: Chemistry
|
quaternary amine
|
|
|
nifedipine: Chemistry
|
dihydropyridine
|
|
|
verapamil: Chemistry
|
phenylalkylamine, racemic isomer, L isomer more active, cleared faster by liver
|
|
|
diltiazem: Chemistry
|
benzothiazepine
|
|
|
ACEIs and ARBs: Chemistry
|
no sulfhydryl except for captopril
|
|
|
Captopril: Chemistry
|
sulfhydryl group
|
|
|
acetazolamide: Chemistry
|
sulfonamide (weeakly acidic)
|
|
|
furosemide: Chemistry
|
sulfanomide
|
|
|
ethacrynic acid: Chemistry
|
not sulfanomide
|
|
|
hydrochlorothiazide: Chemistry
|
sulfonamide
|
|
|
digoxin: Chemistry
|
sugar residues, steroid nucleus, lactone ring---lacks 12-OH residue of digoxin
|
|
|
digitoxin: Chemistry
|
sugar residues, steroid nucleus, lactone ring
|
|
|
streptokinase: Chemistry
|
non enzymatic protein
|
|
|
urokinase: Chemistry
|
low molecular wieght product or something
|
|
|
APSAC: Chemistry
|
plasminogen and streptokinase complex, acylated
|
|
|
reteplase: Chemistry
|
t-PA w/ deleted EGF domain and no glycosylation
|
|
|
TNK t-PA : Chemistry
|
T-PA w/ no glycosylation
|
|
|
ASA with Dipyridamole: Chemistry
|
asparin and dipyridamole, duh
|
|
|
Agatroban: Chemistry
|
small synthetic molecule
|
|
|
neostigmine: Only works if...
|
intact postganglionic innervation
|
|
|
tubocurarine: what increases half life
|
renal impairment
|
|
|
succinylcholine: what increases half life
|
pseudocholinesterase deficiency
|
|
|
dopamine: Tx what shock types?
|
cardiogenic, distributive
|
|
|
dobutamine: Tx what shock types?
|
cardiogenic
|
|
|
norepinephrine: Tx what shock types?
|
distributive
|
|
|
phenylephrine: Tx what shock types?
|
distributive
|
|
|
propranolol: first pass effect
|
nearly total
|
|
|
nifedipine: first pass effect
|
extensive
|
|
|
verapamil: first pass effect
|
extensive
|
|
|
diltiazem: first pass effect
|
extensive
|
|
|
propranolol: hepatic metabolization
|
highly liver metabolized
|
|
|
atenolol: hepatic metabolization
|
less than propranolol
|
|
|
metoprolol: hepatic metabolization
|
less than propranolol
|
|
|
Isosorbide dinitrate: hepatic metabolization
|
big first pass
|
|
|
Isosorbide mononitrates: hepatic metabolization
|
not much, small first pass
|
|
|
mexiletine: hepatic metabolization
|
yeah, clearance reduced in liver disease
|
|
|
digoxin: oral absorption
|
unpredictable w/ tablet, high w/ encapsulated gel preperation---sometimes inactivated in gut by bacteria
|
|
|
propranolol: renal clearance
|
yeah baby
|
|
|
propranolol: tx of portal hypertensive bleeding?
|
yep
|
|
|
atenolol: tx of portal hypertensive bleeding?
|
no, only nonselective
|
|
|
metoprolol: tx of portal hypertensive bleeding?
|
no, only nonselective
|
|
|
propranolol: tx of essential tremor?
|
yep
|
|
|
atenolol: tx of essential tremor?
|
no, only nonselective
|
|
|
metoprolol: tx of essential tremor?
|
no, only nonselective
|
|
|
prazosin: elimination
|
hepatic
|
|
|
Lepirudin: elimination
|
renal, 2 compartment
|
|
|
Agatroban: elimination
|
hepatic metabolism
|
|
|
Isosorbide dinitrate: bioavailability
|
30%
|
|
|
Isosorbide mononitrates: bioavailability
|
100%
|
|
|
nifedipine: bioavailability
|
low
|
|
|
verapamil: bioavailability
|
low
|
|
|
diltiazem: bioavailability
|
low
|
|
|
Isosorbide mononitrates: effect of renal disease
|
little effect
|
|
|
N-acetylprocainamide: effect of renal disease
|
need dose adjustment
|
|
|
NO dependent vasodialtors: dilate stenotic areas?
|
yes
|
|
|
Nitroglycerin: dilate stenotic areas?
|
yes
|
|
|
Isosorbide dinitrate: dilate stenotic areas?
|
yes
|
|
|
Isosorbide mononitrates: dilate stenotic areas?
|
yes
|
|
|
Nitroglycerin: dilate arteries?
|
only at high dose
|
|
|
NO dependent vasodialtors: interactions
|
hypotension w/ sildenafil
|
|
|
nifedipine: interactions
|
inhibit CYP3A4
|
|
|
verapamil: interactions
|
inhibit CYP3A4, increase digoxin, inhibit P-glycoprotein
|
|
|
diltiazem: interactions
|
inhibit CYP3A4
|
|
|
amiodarone: interactions
|
w/ many agents: warfarin, digoxin, procainamide, quinidine to decrease drug metabolism and excretion and increase drug effects
|
|
|
digitalis: interactions
|
drug concentration and toxicity increased by Quinidine, Verapamil, Amiodarone
|
|
|
Ticlopidine: interactions
|
inhibits CYP3A4
|
|
|
NO dependent vasodialtors: critical factor in clinical utility
|
tolerance
|
|
|
Nitroglycerin: critical factor in clinical utility
|
tolerance
|
|
|
Isosorbide dinitrate: critical factor in clinical utility
|
tolerance
|
|
|
Isosorbide mononitrates: critical factor in clinical utility
|
tolerance
|
|
|
nitroprusside: decompososition products
|
NO and CN
|
|
|
nitroprusside: coadministered with what?
|
Na thiosulfate, antidote to CN
|
|
|
hydralazine: metabolism
|
acetylation, variable
|
|
|
Warfarin: metabolism
|
in liver by CYP2C9, big variability
|
|
|
nifedipine: protein bound?
|
yep
|
|
|
verapamil: protein bound?
|
yep
|
|
|
diltiazem: protein bound?
|
yep
|
|
|
Warfarin: protein bound?
|
Yeah, bitches
|
|
|
Captopril: drug specific adverse effects
|
skin rash, neutropenia (from sulfhydryl group)
|
|
|
hydrochlorothiazide: drug specific adverse effects
|
K loss, H loss (metabolic alkalosis), *gout* in susceptible patients
|
|
|
ACE Inhibitors: class specific effects
|
angioedema & cough; hyperkalemia (dec aldosterone); ACEI induced renal insufficiency
|
|
|
ACE Inhibitors: effect on glomerulus
|
no angiotensin II to stimulate efferent arteriole contraction -> reduced GFR
|
|
|
Losartan: active metabolite
|
EXP-3174
|
|
|
procainamide: active metabolite
|
N acetylprocainamide blocks K channels
|
|
|
acetazolamide: GI absorption
|
well absorbed
|
|
|
acetazolamide: Elimination
|
eliminated by kidney, actively secreted by organic acid transport system in proximal tubule
|
|
|
furosemide: acts at what surface of tubule cell
|
luminal
|
|
|
ethacrynic acid: acts at what surface of tubule cell
|
luminal
|
|
|
triamterene: acts at what surface of tubule cell
|
luminal
|
|
|
amiloride: acts at what surface of tubule cell
|
luminal
|
|
|
furosemide: effect on Ca++ excretion
|
more excreted
|
|
|
ethacrynic acid: effect on Ca++ excretion
|
more excreted
|
|
|
hydrochlorothiazide: effect on Ca++ excretion
|
less excreted
|
|
|
Nernst equation: ?
|
Ex=(RT/F) ln [X]o/[X]i
|
|
|
clinical arrhythmia: most common mechanism
|
reentry
|
|
|
clinical arrhythmia: 3 requirements of reentry arhythmia
|
1) functionally or anatomically at least 2 pathwys
2) conditions (as with premature beat) that create unidirectional block in one pathway while impulse continues conduction in the other 3) resulting conduction is slow enough that the area of initial impulse block recovers excitability and can be reentered by impulse from other pathway |
|
|
clinical arrhythmia: most common unidirectional block
|
premature beat
|
|
|
quinidine: incites early afterdepolarizations (EADs)?
|
yup
|
|
|
procainamide: incites early afterdepolarizations (EADs)?
|
yup
|
|
|
N-acetylprocainamide: incites early afterdepolarizations (EADs)?
|
yup
|
|
|
sotalol: incites early afterdepolarizations (EADs)?
|
yup
|
|
|
ibutilide: incites early afterdepolarizations (EADs)?
|
yup
|
|
|
catecholamines: incites early afterdepolarizations (EADs)?
|
nope
|
|
|
INOTROPES: incites early afterdepolarizations (EADs)?
|
nope
|
|
|
quinidine: incites delayed afterdepolarizations (DADs)?
|
nope
|
|
|
procainamide: incites delayed afterdepolarizations (DADs)?
|
nope
|
|
|
N-acetylprocainamide: incites delayed afterdepolarizations (DADs)?
|
nope
|
|
|
sotalol: incites delayed afterdepolarizations (DADs)?
|
no
|
|
|
ibutilide: incites delayed afterdepolarizations (DADs)?
|
no
|
|
|
catecholamines: incites delayed afterdepolarizations (DADs)?
|
yup
|
|
|
INOTROPES: incites delayed afterdepolarizations (DADs)?
|
yup
|
|
|
early afterdepolarization (EAD): reversed by
|
rapid rates, high potassium
|
|
|
delayed afterdepolarization (DAD): reversed by
|
verapamil
|
|
|
quinidine: torsades de pointes?
|
yep, 2-5% incidence, daaaamn
|
|
|
quinidine: major EKG change?
|
inc QRS, inc QT
|
|
|
procainamide: major EKG change?
|
inc QRS, inc QT
|
|
|
disopyramide: major EKG change?
|
inc QRS, inc QT
|
|
|
lidocaine: major EKG change?
|
none
|
|
|
mexiletine: major EKG change?
|
none
|
|
|
tocainide: major EKG change?
|
none
|
|
|
phenytoin: major EKG change?
|
none
|
|
|
flecainide: major EKG change?
|
Marked inc PR; inc QRS; +/- inc QT
|
|
|
propafenone: major EKG change?
|
Marked inc PR; inc QRS; +/- inc QT
|
|
|
encainide: major EKG change?
|
Marked inc PR; inc QRS; +/- inc QT
|
|
|
moricizine: major EKG change?
|
inc PR; inc QRS
|
|
|
propranolol: major EKG change?
|
dec heart rate; inc PR
|
|
|
sotalol: major EKG change?
|
dec heart rate; inc PR; inc QT (K blocking)
|
|
|
esmolol: major EKG change?
|
dec heart rate; inc PR; inc QT (K blocking)
|
|
|
amiodarone: major EKG change?
|
inc QT
|
|
|
bretylium: major EKG change?
|
inc QT
|
|
|
verapamil: major EKG change?
|
decreased HR; inc PR
|
|
|
diltiazem: major EKG change?
|
decreased HR; inc PR
|
|
|
adenosine: major EKG change?
|
decreased HR; inc PR
|
|
|
quinidine: Electrophysiology
|
intermediate recovery of Na blockade (1-5 s); inc action potential duration = block of phase 3 K currents
|
|
|
procainamide: Electrophysiology
|
intermediate recovery of Na blockade (1-5 s); inc action potential duration = block of phase 3 K currents
|
|
|
disopyramide: Electrophysiology
|
intermediate recovery of Na blockade (1-5 s); inc action potential duration = block of phase 3 K currents
|
|
|
lidocaine: Electrophysiology
|
fast recovery from I-Na block, shorten repolarization
|
|
|
mexiletine: Electrophysiology
|
fast recovery from I-Na block, shorten repolarization
|
|
|
tocainide: Electrophysiology
|
fast recovery from I-Na block, shorten repolarization
|
|
|
phenytoin: Electrophysiology
|
fast recovery from I-Na block, shorten repolarization
|
|
|
flecainide: Electrophysiology
|
very slow recover from I Na block, no major effect on repolarization
|
|
|
propafenone: Electrophysiology
|
Na channel blocker
|
|
|
amiodarone: Electrophysiology
|
dec outward K currents
|
|
|
bretylium: Electrophysiology
|
dec outward K currents
|
|
|
quinidine: Antiarrhythmia Class?
|
Ia
|
|
|
procainamide: Antiarrhythmia Class?
|
Ia
|
|
|
disopyramide: Antiarrhythmia Class?
|
Ia
|
|
|
lidocaine: Antiarrhythmia Class?
|
Ib
|
|
|
mexiletine: Antiarrhythmia Class?
|
Ib
|
|
|
tocainide: Antiarrhythmia Class?
|
Ib
|
|
|
phenytoin: Antiarrhythmia Class?
|
Ib
|
|
|
flecainide: Antiarrhythmia Class?
|
Ic
|
|
|
propafenone: Antiarrhythmia Class?
|
Ic
|
|
|
encainide: Antiarrhythmia Class?
|
Ic
|
|
|
moricizine: Antiarrhythmia Class?
|
Ic
|
|
|
propranolol: Antiarrhythmia Class?
|
II
|
|
|
sotalol: Antiarrhythmia Class?
|
II, III
|
|
|
esmolol: Antiarrhythmia Class?
|
II, III
|
|
|
amiodarone: Antiarrhythmia Class?
|
I, II, III, IV
|
|
|
bretylium: Antiarrhythmia Class?
|
III
|
|
|
ibutilide: Antiarrhythmia Class?
|
III
|
|
|
dofetilide: Antiarrhythmia Class?
|
III
|
|
|
verapamil: Antiarrhythmia Class?
|
IV
|
|
|
diltiazem: Antiarrhythmia Class?
|
IV
|
|
|
adenosine: Tx of Atrial flutter to slow ventricular response?
|
yup, diagnostically
|
|
|
propranolol: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
sotalol: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
esmolol: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
verapamil: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
diltiazem: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
digitalis: Tx of Atrial flutter to slow ventricular response?
|
Yup
|
|
|
quinidine: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
procainamide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
disopyramide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
flecainide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
propafenone: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
encainide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
moricizine: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
propranolol: Tx of Atrial flutter to convert to normal rythm?
|
No
|
|
|
sotalol: Tx of Atrial flutter to convert to normal rythm?
|
No
|
|
|
esmolol: Tx of Atrial flutter to convert to normal rythm?
|
No
|
|
|
amiodarone: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
bretylium: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
ibutilide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
dofetilide: Tx of Atrial flutter to convert to normal rythm?
|
Yup
|
|
|
verapamil: Tx of Atrial flutter to convert to normal rythm?
|
no
|
|
|
diltiazem: Tx of Atrial flutter to convert to normal rythm?
|
no
|
|
|
digitalis: Tx of Atrial flutter to convert to normal rythm?
|
no
|
|
|
adenosine: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
drug of choice, bitches
|
|
|
quinidine: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
procainamide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
disopyramide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
flecainide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
propafenone: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
encainide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
moricizine: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
No
|
|
|
esmolol: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
Yep, acutely
|
|
|
amiodarone: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
no
|
|
|
bretylium: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
no
|
|
|
ibutilide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
no
|
|
|
dofetilide: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
no
|
|
|
verapamil: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
yeah, acutely or chronically (IV or oral)
|
|
|
diltiazem: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
yeah, acutely or chronically (IV or oral)
|
|
|
digitalis: Tx of Supraventricular reentrant tachycardia (thru AV node)
|
yeah, acutely or chronically (IV or oral)
|
|
|
AV nodal blocker: Tx of supraventricular reentrant tachycardia using bypass tract
|
NO!
|
|
|
quinidine: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah, w/ beta blocker
|
|
|
procainamide: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah, w/ beta blocker
|
|
|
disopyramide: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah, w/ beta blocker
|
|
|
flecainide: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah
|
|
|
propafenone: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah
|
|
|
encainide: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah
|
|
|
moricizine: Tx of supraventricular reentrant tachycardia using bypass tract
|
yeah
|
|
|
amiodarone: Tx of supraventricular reentrant tachycardia using bypass tract
|
Yes
|
|
|
bretylium: Tx of supraventricular reentrant tachycardia using bypass tract
|
Yes
|
|
|
ibutilide: Tx of supraventricular reentrant tachycardia using bypass tract
|
Yes
|
|
|
dofetilide: Tx of supraventricular reentrant tachycardia using bypass tract
|
Yes
|
|
|
procainamide: Tx of ventricular arrhythmia?
|
yeah
|
|
|
lidocaine: Tx of ventricular arrhythmia?
|
Yeah acutely IV
|
|
|
mexiletine: Tx of ventricular arrhythmia?
|
Yeah, chronic (oral)
|
|
|
tocainide: Tx of ventricular arrhythmia?
|
Yeah, chronic (oral)
|
|
|
sotalol: Tx of ventricular arrhythmia?
|
yeah, oral-chronic
|
|
|
amiodarone: Tx of ventricular arrhythmia?
|
Yeah IV or oral
|
|
|
adenosine: Tx undiagnosed wide complex tachycardia? (could be PSVT or VT)
|
yeah
|
|
|
procainamide: Tx undiagnosed wide complex tachycardia? (could be PSVT or VT)
|
yeah
|
|
|
lidocaine: Tx undiagnosed wide complex tachycardia? (could be PSVT or VT)
|
yeah
|
|
|
amiodarone: Tx undiagnosed wide complex tachycardia? (could be PSVT or VT)
|
yeah
|
|
|
verapamil: Tx undiagnosed wide complex tachycardia? (could be PSVT or VT)
|
NO!!!
|
|
|
adenosine: Tx narrow complex tachycardia?
|
yeah narrow complex = slow response = AV node
|
|
|
lidocaine: Tx narrow complex tachycardia?
|
CHF reduces volume of distribution (wtf?)
|
|
|
esmolol: Tx narrow complex tachycardia?
|
yeah narrow complex = slow response = AV node
|
|
|
verapamil: Tx narrow complex tachycardia?
|
yeah narrow complex = slow response = AV node
|
|
|
flecainide: mortality in pts w/ MI
|
incrased
|
|
|
encainide: mortality in pts w/ MI
|
increased
|
|
|
procainamide: disease inhibiting clearance?
|
renal disease
|
|
|
lidocaine: disease inhibiting clearance?
|
liver disease and heart failure
|
|
|
ANTIARRHTHMICS: which ones worsen heart failure?
|
flecainide, beta blockers, verapamil
|
|
|
drugs: which ones treat heart failure?
|
vasodilators (ACEIs, ARBs, hydralazine w/ isosorbide dinitrate)
beta blockers--be cautious aldosterone antagonists like spironolactone (severe heart failure) |
|
|
digoxin: interactions which diminish absorption
|
cholestyramine, antacids, Kaopectate, bran
|
|
|
digoxin: interactions which increase concentration
|
antibiotics (if kill gut bacteria)
quinidine, verapamil, and amiodarone (inhibit P-glycoprotein) hypokalemia increases effect/toxicity |
|
|
streptokinase: fibrin-specific plasminogen activator?
|
no
|
|
|
urokinase: fibrin-specific plasminogen activator?
|
no
|
|
|
APSAC: fibrin-specific plasminogen activator?
|
no
|
|
|
t-PA: fibrin-specific plasminogen activator?
|
yeah baby
|
|
|
streptokinase: inactivation
|
preexisting antibodies
|
|
|
urokinase: inactivation
|
PAI-1
|
|
|
t-PA: inactivation
|
glycosylated, PAI-1
|
|
|
Unfractionated Heparin: effect monitoring
|
PTT
|
|
|
Vd: Equation?
|
Vd = amount/plasma concentration
|
|
|
CL: Equation?
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Cl = rate of elimination/plasma concentration
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half life: Equation?
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.7*Vd/CL
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Loading dose: Equation?
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Loading dose = Cp * Vd/F
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Maintenance dose: Equation?
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Maintenance dose = Cp * CL/F
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Therapeutic index: Equation?
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TD50/ED50 = median toxic dose/ median effective dose = therapeutic index
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