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77 Cards in this Set
- Front
- Back
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blood sampling should occur at least -- to -- hrs after dose
preferably should occur -- to --- hrs after dose |
6-8
12-24 |
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what limits the bioavailabity of dig
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p glycoprotein
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where is dig absorbed
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upper sm intestine
gi tract |
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what can increase the F of dig
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antibiotics: tetracycline and erythromycin
intestinal bacteria form dihydro metabolites |
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usual desired tx range of dig
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0.5 - 1.0 ng/ml
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target range of HF
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0.5-1.0 ng/ml
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time to ss of dig
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140-220 hrs
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iv loading of dig
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10 ug/kg
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po loading dose of dig
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10-15 ug/kg
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if the pt's renal cl is > 50ml/min what % of the normal recommended maintenance doe should be given
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100
over 24 hrs |
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if pt's Clcr is 10-50 ml/min what % of dose should be given
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24-75%
over 24-36 hr |
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time to ss of dig
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140-220 hrs
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iv loading of dig
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10 ug/kg
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po loading dose of dig
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10-15 ug/kg
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if the pt's renal cl is > 50ml/min what % of the normal recommended maintenance doe should be given
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100
over 24 hrs |
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if pt's Clcr is 10-50 ml/min what % of dose should be given
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24-75%
over 24-36 hr |
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if pt's renal cl is < 10 ml/min how much of the dose should be given?
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10-25%
over 48 hrs |
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dig cl equation
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dig cl (L/hr)= 3 + (0.0546xCLcr)
x by 0.56 if pt also taking quinidine |
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toxicities of dig
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anorexia
nausea vomiting confusion altered color perception arrhythmias |
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reason to measure sdc:
when there's question of --- |
toxicity
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reason to measure sdc:
to investigate reasons for --- ---- |
poor response
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reason to measure SDC:
pt started on --- --- known to interact |
concomittant drugs
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reason to measure sdc:
pt w/ change -- --- |
renal fx
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f/u w/ pts w/ hf
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q 1-2 yrs
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measurement of sdc w/ adequate respsonse and no evidence of toxicity " just ot see what the dig level is: is -- ---
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not justified
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desired range in HF
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0.5 - 1 ng/ml
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to minmize tox risk what should be the con of dig
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< 2mg/ml
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tx range that most labs will report
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0.8-2.0 ng/ml
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even if pt has no s/s, will the dose be reduced if dig level more than 2.0 ug/ml
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yes
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if pt's dig level is less than 0.8 ug/ml and well controlled should the dose be increased to meet tx range
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no
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what will affect Css
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F
CL |
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what should be monitored when taking dig
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renal fx
dig clearance 70% renal |
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what meds will reduce dig
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oral antacids
bile acid sequestrants kaolin-pectin |
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when to take meds that reduce dig
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give dig 1 hr before or 2-3 hr after these drugs
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what will increase the F of dig
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antibiotics
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what will increase the dig SDC by 2-3 fold
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quinidine
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quinidine causes a decrease in dig --- and ---- and an increase in dig ----
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decrease Vd and CL
increase SDC |
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with quinidine you will see an ------- increase in
and a new steady state will be achieved in -- to --- |
immediate
5-7 days |
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w/ quinidine you may consider reducing dig dose by ---- upon initiation of quinidine and monitor
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1/2
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quinidine inibits --- ----
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p-glycoprotein
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--- will increase dig by 70 - 100%
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amiodarone
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w/ amiodarone reduce dig dose by ----%
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25-50%
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interaction of amiodarone and dig is -- ---
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dose dependent
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--- may increase dig by 60-90% due to decreased renal and nonrenal
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verapamil
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amiodarone and verapamil are ---- inhibitors
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p glycoprotein
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p-gp inhibitors will increase/decrease bioavailabilty and increase/decrease CL and thus lead to increased/decreased conc
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increase
decrease increased |
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inducer of p-gp
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rifampin
will decrease plasma levels |
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t/f
warfarin has high Vd |
f
small |
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plasma protein binding of warfarin
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>99%
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which is more important in pharmcokinetics
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S
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t/f
protein binding of warfain diplament is clinically significant |
f
cuz the increase in free fraction is not associated w/ free warfacin drug. . . no increase in effect |
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changes in protein binding ---- clinically relevant
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rarely
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metabolism of warfarin
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hepatic
nearly 100% |
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S metobolized by
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CYP2C9
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R metabolized by
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CYP 1A2
CYP3A4 |
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CYP2C9 inducers
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barbituates
carbamazepine phenytoin primidone rifampin |
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CYP2C9 inhibitors
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amiodarone
fluconazole |
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cyp1A2 inducers
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smoking
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cyp1A2 inhibitors
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fluvoamine
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cyp3A4 inducer
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rifampim
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cyp3A4 inhibitors
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ketoconazole
ritonavir |
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amiodarone has --, ---, --- absorption
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slow
erratic variable |
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amiodarone is ---- distributed
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extensively
to most body tissues |
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how is amiodarone excreted
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almost entirely in feces as unchanged drug and metabolite (biliary excretion)
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t1/2 of amiodarone
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53 days
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due to long t1/2 what's necessary of amiodarone
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loading dose
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most loading doses of amiodarone lasts
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2-3 weeks
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amiodarone inhibits --, -- and ---
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p-gp
CYP2C9 CYP2D6 |
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most significant interactions of amiodarone
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warfarin
dig |
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what do you do when starting amiodarone and pt on warfarin and dig
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reduce dose by 1/2
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why can drug interactios occur even after amiodarone d/ced
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cuz of long t1/2
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interactions of amiodarone can occure w/
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bb
ccb's |
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ae of statins
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myalgia
serum creatine kinase elevation rhabdomyolysis |
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about 50% of rhabo cases due to
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drug-drug interaction w/ statins
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what takes statin into hepatocyte
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OAT
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where do you find cyp3A and cyp2c9 that will affect statin
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hepatocyte
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which statin are hydrophillic
why is that significant |
pravastatin
rosuvastatin very small amount metabolized mainly eliminated unchaged |
