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42 Cards in this Set

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atropine
- belladonna anti-cholinergic
- mad as a hatter, red as a beet, blind as a bat, dry as a bone
- adrenaline rush, hyperdynamic, mydriasis, stop secretions
anticholinergic effect on AV node
open gateway to ventricles for unopposed sympathetic activity
what are organophosphates? what 2 drugs are antidotes?
cholinesterase inhibitor; use atropine or pralidoxime (new reactivator)
ipratropium
works like atropine on bronchi; bulky version so no penetration into CNS; used in COPD, not acute asthma
describe the 4 classes of anti-arrhythmic drugs
class I: cardiac anesthetic blocks fast Na+ channel; subclasses a, b, c

class II: beta blocker

class III: prolongs repolarization in phase 3 of action potential

class IV: calcium channel blocker
name 2 class Ia anti-arrhythmics; what other effect does this class have?
quinidine, procainimide; prolongs repolarization
name 2 class Ib anti-arrhythmics; what is the second effect of this drug on the AP?
lidocaine, tocainide; shortens repolarization
name 1 class Ic anti-arrhythmic; what is the second effect on the AP?
propafenone; no secondary effect; this class is the newest but has pro-arrhythmic effects and is considered least effective of the a,b,c
name 2 class III anti-arrhythmics
bretylium, amiodarone
name 3 class IV anti-arrhythmics
verapamil, diltiazem, nifedipine
which phases of the AP are missing in the SA and AV nodes?
phases 0 and 1
which 4 cardiac drugs are notable for causing heart block?
ABCD

Adenosine
Beta-blockers
Calcium channel blockers
Digoxin

don't give 2 of these at the same time!!
amrinone is a cardiac inotrope, causing + contractility...how does it do this?
poisons cAMP phosphodiesterase, as does Aminophylline, Anti-inflammatories, Asprin
can diuretics cause edema? vasodilators?
YES! decrease renal perfusion, triggering salt and water retention; YES! dilated vessels leak
what are the 11 categories of heart drugs?
AAA
ACE inhibitors
Anesthetics
Anti-coagulants

B
Beta-blockers

CCC
Calcium channel blockers
Clot busters
Cholesterol & triglyceride lowering drugs

DDDD
Diuretics
Digoxin and other inotropes
Delayed repolarizing drugs
Direct vasodilator
what is one cause of myxedema, ie. widespread mucopolysaccharide deposits
severe hypothyroidism
what are the 3 key features of angiotensin II?
- potent vasoconstrictor
- triggers aldosterone release
- sensitize tissues to epinephrine
name 4 test-relevant ACE inhibitors
Captopril
Enalapril/AT
Quinapril
Fosinopril
what are 4 side effects from ACE inhibitors?
hypotension
proteinuria
hyperkalemia
cough
what is the effect of ACE inhibitors on bradykinin?
increases
which ACE inhibitor is "tissue active"? what does that mean?
quinapril; hardens newly-formed soft atherosclerotic plaques to help avoid MI
which ACE inhibitor prolongs life in CHF? which is a pro-drug metabolized in the liver?
captopril; enalapril
name an angiotensin 1 receptor blocker; how is it better than an ACE inhibitor?
losartan; no cough side effect
when should ACE inhibitors be used?
high renin hypertension:
diabetes
CHF
COPD
peripheral vascular disease
explain the digoxin/quinidine reciprocal relationship
quinidine quickens AV transit
digoxin slows AV transit

quinidine depresses myocardium
digoxin stimulates myocardium
what 3 cardiac drugs can lead to Lupus-like syndrome?
procainamide (class Ia anesthetic)
hydralizine (direct vasodilator)
minoxidil (direct vasodilator)
how can quinidine increase serum digoxin levels?
bumps digoxin off skeletal muscle binding sites
first DOC in CHF?
ACE inhibitors
use beta blockers in CHF?
yes, but only in small doses and preferably beta1 selective; works by giving the heart a rest from constant adrenergic bombardment
what are the A,B,C,D's in CHF?
ACE inhibitors
Beta blockers
Causes
Diuretics/digitalis/dilators
describe the D's in CHF
Diuretics: thiazide diuretics for MILD CHF, furosemide for MODERATE and BOTH for SEVERE

Digitalis: improves life, but doesn't prolong

Dilators: nitroglycerine and isosorbide dinitrate, decrease pre-load and some decreased after-load
what is said about triamterene in CHF?
prolongs life; a diuretic only available with hydrochlorothiazide
what do you do in acute pulmonary edema? (paroxysmal nocturnal dyspnea)
"FIND the answer"

Furosemide, morphine, nitroglycerine
Intravenous nitroglycerine
Nitroprusside, Dobutamine
pair and compare digitalis and quinidine: myocardial irritability and contractility, AV node conduction
digitalis: increases contractility, irritability, slows conduction through AV node

quinidine: decreases contractility and irritability, "quickens" AV node conduction (myocardial depression can lead to CHF)
what do you give in atrial flutter?
first digitalis, then quinidine; NEVER give quinidine alone; be careful of dosing: quinidine displaces digoxin from skeletal muscle binding sites
difference between aspirin and NSAIDs?
both inhibit cyclooxygenase, thus blocking prostaglandins; asprin binds irreversibly
heparin
anticoagulant

A: blocks conversion of fibrinogen to fibrin by anti-thrombin III

X: large polymer of disaccharide

I: DVT, TIA, PE, heart valve embolism, angina pectoris
warfarin (Coumarin)
anti-clotting drug; "WEPT" = Warfarin Extrinsic Prothrombin Time

A: vitamin K analogue, so lowers availability of II, VII, IX, X

I: DVT, TIA, PE, heart valve embolism, angina pectoris
asprin, naproxen
anti-platelet drugs

A: aspirin inhibits COX permanently, naproxen does so temporarily

X: bleeding

I: DVT, TIA, PE, heart valve embolism, angina pectoris
risk factors for DVT
MS Estrogen

Malignancy
Stasis

Estrogen (increase factors II, VII, IX, X)
ticlopidine
anti-platelet

A: blocks platelet binding to factor I

X: neutropenia

I: DVT, TIA, PE, heart valve embolism, angina pectoris
what 3 vitamins are made in the body or gut, but still need dietary input?
vitamin D: steroid nucleus, UV light, liver and kidney hydroxylation

vitamin K: made by colonic bacteria and requires bile for absorption

niacin: made from tryptophan