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511 Cards in this Set

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botulinum toxin: class
anti-cholinergic
carbidopa: class
anti-adrenergic
tyramine: class
adrenergic
phenylephrine: class
alpha agonist
methoxamine: class
alpha agonist
norepinephrine: class
alpha agonist
phenylephrine: class
alpha agonist
dopamine: class
alpha agonist
phentolamine: class
allpha antagonist
phenoxybenzamine: class
allpha antagonist
prazosin: class
allpha antagonist
clonidine: class
centrally acting alpha agonist
methyldopa: class
centrally acting alpha agonist
yohimbine: class
alpha 2 antagonist
isoproterenol: class
beta agonist
dobutamine: class
beta agonist
propranolol: class
beta blocker
metoprolol: class
beta blocker
atenolol: class
beta blocker
bromocriptine: class
dopamine agonist
ephedrine: class
indirectly acting pheylethylamine
phenylpropanolamine: class
indirectly acting pheylethylamine
pseudoephedrine: class
indirectly acting pheylethylamine
methacholine: class
muscarinic agonist
bethanechol: class
muscarinic agonist
pilocarpine: class
muscarinic agonist
atropine: class
muscarinic antagonist

(competitive inhibitor)
nicotine: class
nicotinic agonist
insecticides: class
cholinesterase inhibitor
physostigmine: class
cholinesterase inhibitor
neostigmine: class
cholinesterase inhibitor
organophosphates: class
cholinesterase inhibitor
tubocurarine: class
Nondepolarizing neuromuscular blocker
succinylcholine: class
depolarizing neuromuscular blocker
dantrolene: class
spasmolytic
botulinum toxin: administration
local injection
tubocurarine: administration
parenteral
succinylcholine: administration
parenteral
propranolol: administration
IV, oral (40x greater oral b/c 1st pass effect)
esmolol: administration
IV only
methyldopa: administration
IV as its ethyl ester
phenoxybenzamine: administration
oral
phentolamine: administration
IV
Nitroglycerin: administration
orally, sublingual, transdermal, spray to buccal mucosa, IV
Isosorbide dinitrate: administration
oral
nitroprusside: administration
IV only, with glucose water solution
mannitol: administration
IV
quinidine: administration
oral
procainamide: administration
IV
lidocaine: administration
IV
mexiletine: administration
oral
tocainide: administration
oral
esmolol: administration
IV
ibutilide: administration
IV
inamrinone: administration
IV
streptokinase: administration
IV
t-PA: administration
IV
reteplase: administration
IV, double bolus
TNK t-PA : administration
single bolus
Unfractionated Heparin: administration
never IM goddamit. IV and subq
Lepirudin: administration
IV
Agatroban: administration
IV
Warfarin: administration
oral, 100% absorption
lidocaine: distribution and elimination times
8 min dist, 108 min elim...elim t1/2 determines time to steady state and maintanence dosing
phenoxybenzamine: time to clinical effect
hours
methyldopa: time to clinical effect
six hours (must be metabolized)
Nitroglycerin: time to clinical effect
minutes
Isosorbide dinitrate: time to clinical effect
30-90 min
Isosorbide mononitrates: time to clinical effect
30-60 min
Losartan: time to clinical effect
3-4 hours
amiodarone: time to clinical effect
slow accumulation to steady state
Ticlopidine: time to clinical effect
delay in onset 5=10 dias
botulinum toxin: duration/half life
weeks/months
phentolamine: duration/half life
short acting
phenoxybenzamine: duration/half life
days
tubocurarine: duration/half life
60 min half life
succinylcholine: duration/half life
5-10 min half life
propranolol: duration/half life
3-6 hours
esmolol: duration/half life
9 min
phenoxybenzamine: duration/half life
over a day
terazosin: duration/half life
3-4 hours
Nitroglycerin: duration/half life
30 min-hrs
Isosorbide dinitrate: duration/half life
hrs
Isosorbide mononitrates: duration/half life
hrs
nitroprusside: duration/half life
short, minutes
nifedipine: duration/half life
long acting
verapamil: duration/half life
long acting
diltiazem: duration/half life
long acting
esmolol: duration/half life
9 min half life
amiodarone: duration/half life
very long, 40-60 days
inamrinone: duration/half life
elimination half life 2.5 hours, but can be >12 hours in CHF pts
APSAC: duration/half life
stupid long, yo. 60 mins
t-PA: duration/half life
stupid short, yo. 6 minutes
Ticlopidine: duration/half life
effects persist several days
Lepirudin: duration/half life
slower clearance than heparin, can give sub q
digoxin: time to steady state after maintanance dosages started
1 week
digitoxin: time to steady state after maintanance dosages started
1 month
botulinum toxin: mechanism
blocks release of Ach
tyramine: mechanism
displaces norepinephrine into synaptic cleft
methyldopa: mechanism
metabolized to alphamethylnorepinephrine, which stimulates presynaptic alpha 2 receptors
ephedrine: mechanism
indirectly acting adrenergic
pseudoephedrine: mechanism
indirectly acting adrenergic
methacholine: mechanism
muscarinic agonist
bethanechol: mechanism
muscarinic agonist
pilocarpine: mechanism
muscarinic agonist
pralidoxime: mechanism
reactivates cholinesterase
organophosphates: mechanism
cholinesterase inhibition
tubocurarine: mechanism
nondepolarizing blockade at neuromuscular jnx
succinylcholine: mechanism
depolarizing neuromuscular blockade
dantrolene: mechanism
reduces release of Ca++ from sarcoplasmic reticulum
atenolol: mechanism
beta 1 selective blocker
metoprolol: mechanism
beta 1 selective blocker
labetalol: mechanism
alpha 1 antagonist; beta 1 antagonist; beta 2 agonist
labetalol RR stereoisomer: mechanism
beta 1 antabonist and partial beta 2 agonist
labetalol SR stereoisomer: mechanism
alpha 1 antagonist
carvedilol, R isomer: mechanism
alpha 1 blocker
carvedilol, S isomer: mechanism
beta blocker and alpha 1 blocker
NO dependent vasodialtors: mechanism
activates guanylate cyclase, inc cGMP, cGMP activates protein kinase -> dilation of veins (major) and coronary vessels (minor)
sildenafil: mechanism
inhibits cGMP phosphpodiesterase Type V
hydralazine: mechanism
who the fuck knows?
minoxidil: mechanism
opens ATP sensitve K+ channel in arterial smooth muscle, dilates arteries
Captopril: mechanism
block conversion of Ang I to Ang II, block degradation of bradykinin
mannitol: mechanism
filtered but not resorded, osmotically inspired diuresis
furosemide: mechanism
inhibit contransport of Na, Cl, and K at the luminal membrane of the thick ascending limb of Henle's loop
ethacrynic acid: mechanism
inhibit contransport of Na, Cl, and K at the luminal membrane of the thick ascending limb of Henle's loop
hydrochlorothiazide: mechanism
inhibit Na transport in distal convoluted tubule (Na-Cl cotransporter)
triamterene: mechanism
inhibit luminal Na channel in collecting tubules
amiloride: mechanism
inhibit luminal Na channel in collecting tubules
quinidine: mechanism
block Na and K currents, alpha block and vagal inhibition
procainamide: mechanism
blocks Na and K channels
sotalol: mechanism
non selective beta blocker, K channel blocker
ibutilide: mechanism
K blocker, Na opener
digitalis: mechanism
increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
digoxin: mechanism
increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
digitoxin: mechanism
increases myocardial intracellular Ca++ by blocking Na-K ATPase...also anti-symp pro-vagal effects
inamrinone: mechanism
inhibits phosphodiesterase Type III (cardiac), increased cAMP -> increased intracellular Ca++
streptokinase: mechanism
indirect plasminogen activator...binds w/ a plaminogen molecule, complex activates 2nd molecule
urokinase: mechanism
direct plasminogen activator
t-PA: mechanism
binds to fibrin, directly activates plasminogen
reteplase: mechanism
binds to fibrin, directly activates plasminogen
Aspirin: mechanism
inhibits cyclooxygenase, thereby decreasing thromboxane A2
Dipyridamole: mechanism
Inhibits phosphodiesterase to increase accumulation of cAMP, blocks adenosine uptake, prevents platelet activation
Ticlopidine: mechanism
inhibits ADP activation, inhibit glycoprotein Iib/IIIa receptor and vonWillebrand factor
Clopidogrel: mechanism
inhibits ADP activation, inhibit glycoprotein Iib/IIIa receptor and vonWillebrand factor
Abciximab: mechanism
antibody to glycoprotein Iib/IIIa
Unfractionated Heparin: mechanism
inactivates coag factors, most importantly II and X
Low-Molecular Weight Heparins: mechanism
bind antithrombin-III/thrombin (little effect on PTT)
Lepirudin: mechanism
direct thrombin inactivator
Agatroban: mechanism
directly reversibly inhibits thrombin
Warfarin: mechanism
inhibits vitamin K, thusinhibits II, VII, IX, X, protein C, and protein S
digitalis: electrophysiologic effects on His-Purkinje system
resting potential more positive; Action Potential duration shortens; enhanced phase 4 depolarization (automaticity) at higher concentrations
carbidopa: receptor, effect
inhibits dopa decarboxylase (dopa to dopamine)
phentolamine: receptor, effect
alpha 1; competitive antagonist
phenoxybenzamine: receptor, effect
alpha 1; noncompetitive antagonist
clonidine: receptor, effect
presynaptic alpha 2 stimulation, feedback inhibition of norepinephrine
yohimbine: receptor, effect
blocks alpha 2 receptors in medulla, increased sympathetic outflow
isoproterenol: receptor, effect
stimulates beta 1 and beta 2 receptors
dobutamine: receptor, effect
beta 1 agonist
propranolol: receptor, effect
competitive inhibitor at beta 1 and beta 2
metoprolol: receptor, effect
selective blocker of beta 1
atenolol: receptor, effect
beta 1 blocker
methacholine: receptor, effect
muscarinic agonist
bethanechol: receptor, effect
muscarinic agonist
pilocarpine: receptor, effect
muscarinic agonist
atropine: receptor, effect
muscarinic antagonist
nicotine: receptor, effect
nicotinic agonist
insecticides: receptor, effect
inhibits acetylcholinesterase and pseudocholinesterase
labetolol: receptor, effect
beta blocker and alpha 1 blocker (more pronounced when given orally)
carvedilol: receptor, effect
beta blocker and alpha 1 blocker
nifedipine: receptor, effect
block L-type C++ channel, vascular
verapamil: receptor, effect
block L-type C++ channel, cardio
diltiazem: receptor, effect
block L-type C++ channel, cardio adn vascular
acetazolamide: receptor, effect
noncompetitive inhibition of carbonic anhydrase in proximal tubule, prevents reabsorption of NaHCO3, net secretion of NaHCO3 with obligatory H2O
spironolactone: receptor, effect
competes with aldosterone for cytosolic receptor, prevents aldosterone inspired K excretion and Na reabsorption
amiodarone: lipophilicity
high
carbidopa: clinical use
decrease peripheral dopamine production in anti-parkinsons tx
phenylephrine: clinical use
tx hyptension, cause mydriasis, tx nasal congestions, tx paroxysmal atrial tachycardia
phentolamine: clinical use
dx of pheochromocytoma, emergent tx of pheochromocytoma
phenoxybenzamine: clinical use
tx of pheochromocytoma
clonidine: clinical use
tx of hypertension
yohimbine: clinical use
aphrodisiac
isoproterenol: clinical use
tx gravid uterus, asthma
pseudoephedrine: clinical use
tx nasal congestion
methacholine: clinical use
provoke bronchoconstriction w/ methacholine challenge
bethanechol: clinical use
improving gastric emptying; tx urinary retention
pilocarpine: clinical use
induce salivation; tx open angle glaucoma
atropine: clinical use
tx vasovagal syncope, decrease respiratory secretions
physostigmine: clinical use
tx of anticholinergic syndrome
neostigmine: clinical use
tx atonly of detrusor, tx myasthenia gravis, tx glaucoma
organophosphates: clinical use
kill one's enemies
dantrolene: clinical use
tx of malignant hyperthermia (releave muscle contracture)
tx torsades de pointes
isoproterenol
methyldopa: clinical use
tx htn
clonidine: clinical use
tx htn
Nitroglycerin: clinical use
angina
Isosorbide dinitrate: clinical use
angina
Isosorbide mononitrates: clinical use
angina
sildenafil: clinical use
stiff penis
nitroprusside: clinical use
acute hypertension, perioperative hypertension control, heart failure
hydralazine: clinical use
hypertension (best w/ beta blocker) heart failure (combined w/ nitrates and diuretics)
minoxidil: clinical use
difficult hypertension (need beta blocker and diuretic) hair growth
nifedipine: clinical use
hypertension
acetazolamide: clinical use
tx of glaucoma, acute mountan sickness, metabolic alkalosis
furosemide: clinical use
acute pulmonary edema, severe edema; hypercalcemia
ethacrynic acid: clinical use
acute pulmonary edema, severe edema; hypercalcemia
hydrochlorothiazide: clinical use
tx of essential hypertension, nephrogenic diabetes insipidous, tx hypercalciuria
spironolactone: clinical use
tx of edema of cirrhosis, K sparing used in conjunction with k wasting diuretics, counteract aldosterone escape with ACEIs and ARBs
quinidine: clinical use
chronic oral therapy of atrial fib/flutter (and VT)
procainamide: clinical use
supraventricular and ventricular arrhythmias
amiodarone: clinical use
effective for most arrhythmias; refractory VT/VF
ibutilide: clinical use
atrial flutter, less effective w/ atrial fib
dofetilide: clinical use
Atrial fib/flutter, esp patients w/ left ventric dysfunction
digitalis: clinical use
relieve sx of CHF; supraventricular arrhythmias (but can block AV node completely and cause Atrial fib)
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?
Cl = rate of elimination/plasma concentration
half life: Equation?
.7*Vd/CL
Loading dose: Equation?
Loading dose = Cp * Vd/F
Maintenance dose: Equation?
Maintenance dose = Cp * CL/F
Therapeutic index: Equation?
TD50/ED50 = median toxic dose/ median effective dose = therapeutic index