Pharm Exam 1

Front 1

antiplatelet groups

Back 1

1. Cox inhibitors
2. Phosphodiesterase inhibitors
3. ADP inhibitors

4. GP IIIb-IIa antagonists

Front 2

Aspirin

Back 2

TIA, MI, Thromoboembolic disorders, ACS, stents
arthritis, juvenile arthritis, rheumatic fever

A.R.reyes syndrome, tinnitus, thrombocytopenia, rash, asthma
Contra-bleeding, hepatic impairment, impaired renal function

Front 3

Phosphodiesterase inhibitors

Back 3

•Dipyridamole (Persantine)•
Decreasesplatelet aggregability•
Weakantiplatelet – usually used in combination with ASA or Warfarin
•Thromboembolicdisorders
•Indirectcoronary vasodilator

Front 4

thienopyridines

Back 4

•Alwayed use for CAS
•Block the binding of ADP to a plateletreceptor P2Y
•Inhibits activation of the GP IIb/IIIacomplex and thus prevents platelet aggregation
•Wantto prevent platelet aggregation

Front 5

Ticlid-ticlopidine
Plavix-clopidogrel
Effient-prasugrel

Back 5

1. thrombocytopenia

2. Delayedonset of action•Largeindividual variability in platelet response•Irreversibilityof its inhibitor effect on platelets•Studiesfound 20-25% of patients were Plavix resistant

3. •Morerapid onset of action than others•Ableto achieve higher degree of platelet inhibition vs Plavix•Increasedrisk of bleeding in patient over 75 years of age or weighing less than 60 kg
Can’tuse for any patients that have had a stroke.
off for 7 days. GI discomfort-plavix.

Afib, HTN, HLD H.A. effient

Front 6

Brilenta

Back 6

•New chemical class of antiplatelet agent•Cyclopentyltriazolopyrimidines-cptp class•Oral p2y12 receptor antagonist that blocks adp•Has a different binding site than plavixor effient•Does not require metabolic activation•Peakeffect 2 hours•More consistent antiplatelet effect/moreplatelet inhibition

off for 5 days. SOB

Front 7

GPIIb-IIIa antagonists

Back 7

•Eptifibatide (Integrelin)•Abciximab (Reopro)•Tirofiban (Aggrastat)
ACS, adjunct to PTCI, Unstable angina. must be give iv

Front 8

anticoagulants

Back 8

1. warfarin-vit K expoxide reductase inhibits

mechanical valves only

2. UFH/Lmwh-HIT renal adjustment with lmwh

3. NOACs- Xa inhibitors
praxada- direct thrombin inhibitor

Front 9

NOACS

Back 9

non val afib- eliquis, xarelto, pradaxa, savaysa
DVT/PE- eliquis, xarelto, pradaxa.
Arixtra and savaysa- cant start on
DVT, PE, arthroplasty prophylaxis-all

Front 10

reversals
off for surgery

Back 10

praxbind-pradaxa, xarelto, eliquis fda not approved
prothrobmin complex concentrate-warfin
recombinate factor VIIa- for hemophiliacs

Surgery/Procedure•Xarelto,Pradaxa, Savaysa 24 hours•Eliquis– 48 hours•Majorsurgery – Pradaxa 2-4 days

Front 11

direct thrombin inhibitors

Back 11

bivalrudin-angiomax-hit/ptci
argatroban-hit

Front 12

inhitors/fibrinolysis

Back 12

•Protamine •reverseeffects of heparin. Conclusion of CABG
•Aprotinin•Usedduring cardiac surgeries. May increase post op ARF
•Aminocaproic Acid/Tranexamic Acid•reduceperioperative bleeding during CABG

Front 13

Class Ia

Back 13

•Class I drugs•Inhibitfast sodium channels during depolarization (phase 0)
Decreasesdepolarization rate
Decreasesconduction velocity
Lengthen both action potentialduration/Effective refractory period
•Prolong repolarization owing to K channelblockade
•Quinidine – old not just much
•Procainamide - old not used much•Procainamidechallenge with WPW syndrome•Disopyramide- notmuch use

Front 14

Class Ia uses

Back 14

•Atrial Fibrillation/Flutter
•Wpw (procainamide challenge)
•SVT/VT•
Common Side effects: Nausea, diarrhea•Serious/Common Adverse Effects•Caninduce Torsade's; Complete Heart Block; VT; Anticholinergic effects (Quinidine)•Contraindications•ProlongQT•Myastheniagravis

Front 15

Ib

Back 15

•Less powerful Sodium blockers
•Shorten action potentialduration/refractory period

•Ischemic muscle – Lidocaine blocks ATP dependent channelsthus shortening ventricular repolarization•Lidocaine gtt to suppress VT storm
•Mexiletine
•Phenytoin - seizures_

Front 16

ib uses

Back 16

VT
Local AnesthesiaSeizures
Adverse EffectsAsystole; BradycardiaHypotensionNausea/Vomiting
ContraindicationsWPW; SA/AV/Intraventricular Blocks

Front 17

Ic

Back 17

Most potent Sodium channel blockers

Decrease speed of conduction of cardiac impulsesThis in turn may contribute to the proarrhythmic effects of these drugs

Flecainide

Propafenone

Encainide

moricizine

Front 18

Ic uses

Back 18

Atrial fibrillation
Sustained VT- (amiodarone used more often)Paroxysmal Supraventricular
Tachycardia
Adverse EffectsNausea; Dizziness; DyspneaCan induce Cardiac arrestSinus node dysfunctionProlonged QT
ContraindicationsProarrhythmic Effects, Post MI

Front 19

II

Back 19

B-adrenergic antagonistDecrease rate of phase 4 depolarization which results in decreased autonomic nervous system activity

Suppression of ventricular arrhythmia

Prolongs p-r interval

Decrease incidence of arrhythmia related morbidity/mortality Exact mechanism remains unclear

Front 20

III

Back 20

Potassium ion channel blockers
Prolongs cardiac depolarization/action potential duration/refractory period
Decreases excitability of the myocardial cellsIbutilideDofetilide/tikosyn- must be hospitalized,loading over 3 days,
Sotalol – used for more VT.
Bretylium-no longer available in usAmiodarone( also NA channel blockade; B blocker and calcium channel blockade)( Class I, II and IV)PFTs, thyroid panals,

Dronedarone (multaq)- Less lipophilic (results in shorter half life)Have to stop with acute heart failure- increased mortalityCan reintroduce once exacerbation has cleared up

Front 21

III uses

Back 21

•Atrial Fibrillation/Flutter•VT•SVT•WPW•Adverse Effects•Bradycardia;Torsade's de pointes; Proarrhythmic•Hypotension•Increasedmortality with CHF (Dronedarone)•PulmonaryToxicity; Thyroid Dysfunction; Parkinson like syndrome (rare) (amiodarone)

Front 22

IV

Back 22

Calcium channel blockers-inhibit inward slow calcium ion currents that may contribute to tachycardia.

Non-Dihydropyridine (1st treatment for afib in er)VerapamilDiltiazemUsesRecurrent re-entry psvtAtrial fibrillation –reduce ventricular response rate

Adverse Effects: Bradycardia/hypotension

Front 23

adenosine,

Back 23

adenosine •Inhibits sa node, atrial and av nodalconduction•Av node more sensitive than sa node•Plasma half life of 10 seconds•First line treatment for narrow complexsvt•Adverse effects:•Bradycardia,nausea, vomiting, ha, hypotension•Bronchoconstriction-asthmapts

Front 24

digoxin

Back 24

•Cardiac glycoside•Selective inhibitor of sodium pump•Helps to decrease automaticity at the avnode-prolongs the refractory period and slowing conduction through the node•Uses:•Atrialfibrillation; Heart failure- less common now•Common side effects:•Bradycardia,multiple drug interactions-dig toxicity

Front 25

mag/K

Back 25

•Potassium•Hypokalemia/hyperkalemia•Ectopicbeats/bradycardia•Magnesium•Torsade'sde pointes

Front 26

thiazide

Back 26

first line

inhibits Na/cl at distal convoluted tubule

decrease volume and vasodilator effect.

a.e. hypotension, photo, hypok, hypon

contra-Hctz-QT, sulfa allegy, hctz-hyperglycemia. anuria

Front 27

loop diuretics

Back 27

inhibits Na/CL at loop of henle, distal and prox convuleted tubules.

sulfa allergy use ethacrynic acid-edecrin

Front 28

calcium channel blockers

Back 28

inhibits Ca ion influx into vascular smooth muscle and myocardium

arteriolar dilators.

for angina, spasms, raynauds.

pines.

se-palp, peripheral edema

dihydrophrides little effect on heart rate

Front 29

ace inhibitors

Back 29

htn, CHF, diabetics nephropathy, post MI

cough bradykinin, angioedema, hyperkalemia poteinuria. no to bil renal stenosis, pregnancy, renal failure

Front 30

arbs

Back 30

ATI antagonists

ATII indirectly vasorelax
tans
htn, diabetic nephropathy, chf, post mi, prevention of stroke

Front 31

potassium sparing diurectics

Back 31

inhibits aldosterone

amiloride/tramaterne- natriuretic, diuretic and antihypertensive, inhibits sodium channel

hyperkalemia, gynecomastia.
can be used in liver cirrhosis
avoid in AKI

Front 32

renin inbitiors

Back 32

aliskiren

inhibits renin which converts angiotensinogen to angiotension I

can be used with renal insuff.

causes hypo, angioedema, hyperkalmia

dont use with ace,arb, cyclosporine

Front 33

potassium channels vasodilators

Back 33

minoxidil

severe/refractory HTN, male alopecia

reflux tachy-take bb, peri edema- take diuretic

hypernatur,

Front 34

phosphodiesterase inhitors

Back 34

PDE5

ED, pulm htn

h.a. flushing, hypotension

can not take with nitrates

Front 35

endothelin receptor antagonists

Back 35

Bosentan (Tracleer)- IV or po
Letairis (Ambrisentan)- Can be given once a dayUsed to treat Pulmonary Hypertension
Adverse Effects: Bosentan – Potential for liver toxicity and fetal harm only prescribed thru Tracleer access program
Letairis – Due to risk of birth defects – for female patients restricted through Letairis program

Front 36

natriuretic peptides

Back 36

•Nesiritide –Exogenous BNP
•IV medication used for acutelydecompensated Heart Failure-Short Term•Doesnot decrease mortality
•Smooth muscle relaxation•Works directly on cardiocytes•Decreases PCWP, SVR, Increases strokevolume•Lowers plasma levels of aldosterone andendothelin-1•
Promotes water excretion, but retains Na+•Does not affect Cr as much either•Loading dose followed by gtt•2-3days short term

Front 37

hydralzine

Back 37

dialates peripheral arterioloes

bidil-nitrate and hydralzine

h.a. palpitations, flushing, sle,

can't use with valvular rheumatic heart disease

Front 38

clonidine

Back 38

•Reduce sympathetic outflow from Medulla•Decreases Heart rate, contractility, andvasomotor tone
•Used to treat HTN has diminishedsecondary to adverse effects
•Common Side effects: •Hypotension(orthostatic)•Significantbradycardia•Constipation•Confusion,dizziness•Howto titrate down, can’t just stop
•CADuse BB not clonidine

Front 39

alpha 1 antagonists

Back 39

PrazosinDoxazosinTerazosin
Uses: BPH; Hypertension
Not on JNC 8, but still used for HTN
Adverse Effects: Marked first dose postural hypotensionIncreased urinary frequencyDizziness , syncope