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42 Cards in this Set
- Front
- Back
atropine
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- 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 |
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anticholinergic effect on AV node
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open gateway to ventricles for unopposed sympathetic activity
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what are organophosphates? what 2 drugs are antidotes?
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cholinesterase inhibitor; use atropine or pralidoxime (new reactivator)
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ipratropium
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works like atropine on bronchi; bulky version so no penetration into CNS; used in COPD, not acute asthma
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describe the 4 classes of anti-arrhythmic drugs
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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 |
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name 2 class Ia anti-arrhythmics; what other effect does this class have?
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quinidine, procainimide; prolongs repolarization
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name 2 class Ib anti-arrhythmics; what is the second effect of this drug on the AP?
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lidocaine, tocainide; shortens repolarization
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name 1 class Ic anti-arrhythmic; what is the second effect on the AP?
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propafenone; no secondary effect; this class is the newest but has pro-arrhythmic effects and is considered least effective of the a,b,c
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name 2 class III anti-arrhythmics
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bretylium, amiodarone
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name 3 class IV anti-arrhythmics
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verapamil, diltiazem, nifedipine
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which phases of the AP are missing in the SA and AV nodes?
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phases 0 and 1
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which 4 cardiac drugs are notable for causing heart block?
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ABCD
Adenosine Beta-blockers Calcium channel blockers Digoxin don't give 2 of these at the same time!! |
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amrinone is a cardiac inotrope, causing + contractility...how does it do this?
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poisons cAMP phosphodiesterase, as does Aminophylline, Anti-inflammatories, Asprin
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can diuretics cause edema? vasodilators?
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YES! decrease renal perfusion, triggering salt and water retention; YES! dilated vessels leak
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what are the 11 categories of heart drugs?
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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 |
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what is one cause of myxedema, ie. widespread mucopolysaccharide deposits
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severe hypothyroidism
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what are the 3 key features of angiotensin II?
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- potent vasoconstrictor
- triggers aldosterone release - sensitize tissues to epinephrine |
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name 4 test-relevant ACE inhibitors
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Captopril
Enalapril/AT Quinapril Fosinopril |
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what are 4 side effects from ACE inhibitors?
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hypotension
proteinuria hyperkalemia cough |
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what is the effect of ACE inhibitors on bradykinin?
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increases
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which ACE inhibitor is "tissue active"? what does that mean?
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quinapril; hardens newly-formed soft atherosclerotic plaques to help avoid MI
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which ACE inhibitor prolongs life in CHF? which is a pro-drug metabolized in the liver?
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captopril; enalapril
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name an angiotensin 1 receptor blocker; how is it better than an ACE inhibitor?
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losartan; no cough side effect
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when should ACE inhibitors be used?
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high renin hypertension:
diabetes CHF COPD peripheral vascular disease |
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explain the digoxin/quinidine reciprocal relationship
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quinidine quickens AV transit
digoxin slows AV transit quinidine depresses myocardium digoxin stimulates myocardium |
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what 3 cardiac drugs can lead to Lupus-like syndrome?
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procainamide (class Ia anesthetic)
hydralizine (direct vasodilator) minoxidil (direct vasodilator) |
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how can quinidine increase serum digoxin levels?
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bumps digoxin off skeletal muscle binding sites
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first DOC in CHF?
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ACE inhibitors
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use beta blockers in CHF?
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yes, but only in small doses and preferably beta1 selective; works by giving the heart a rest from constant adrenergic bombardment
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what are the A,B,C,D's in CHF?
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ACE inhibitors
Beta blockers Causes Diuretics/digitalis/dilators |
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describe the D's in CHF
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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 |
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what is said about triamterene in CHF?
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prolongs life; a diuretic only available with hydrochlorothiazide
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what do you do in acute pulmonary edema? (paroxysmal nocturnal dyspnea)
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"FIND the answer"
Furosemide, morphine, nitroglycerine Intravenous nitroglycerine Nitroprusside, Dobutamine |
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pair and compare digitalis and quinidine: myocardial irritability and contractility, AV node conduction
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digitalis: increases contractility, irritability, slows conduction through AV node
quinidine: decreases contractility and irritability, "quickens" AV node conduction (myocardial depression can lead to CHF) |
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what do you give in atrial flutter?
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first digitalis, then quinidine; NEVER give quinidine alone; be careful of dosing: quinidine displaces digoxin from skeletal muscle binding sites
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difference between aspirin and NSAIDs?
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both inhibit cyclooxygenase, thus blocking prostaglandins; asprin binds irreversibly
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heparin
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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 |
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warfarin (Coumarin)
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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 |
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asprin, naproxen
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anti-platelet drugs
A: aspirin inhibits COX permanently, naproxen does so temporarily X: bleeding I: DVT, TIA, PE, heart valve embolism, angina pectoris |
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risk factors for DVT
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MS Estrogen
Malignancy Stasis Estrogen (increase factors II, VII, IX, X) |
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ticlopidine
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anti-platelet
A: blocks platelet binding to factor I X: neutropenia I: DVT, TIA, PE, heart valve embolism, angina pectoris |
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what 3 vitamins are made in the body or gut, but still need dietary input?
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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 |