Shared Flashcard Set

Details

Pharm Combined
KYCOM Block 13
449
Pharmacology
Graduate
01/20/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
what are the 4 epilepsy drugs that work by decreasing Na influx
Definition
oxycarbasepine
carbamazepine
lamotrigene
phenytoin
Term
what are the 5 epilepsy drugs that are mixed MOA
Definition
valproic acid
zonlsamide
topiramate
Gabapentin
pragabalin
Term
what are the 7 epilepsy drugs that interact with GABA
Definition
clonazepam
lorazepam
diazepam
primidone
tigabine
vigabatrin
phenobarbital
Term
what are the 5 epilepsy drugs that i categorized as other
Definition
gabapentin
lavetfracetam
pregabalin
acetazolamide
ethosuxamide
Term
MOA oxycarbamazepine
Definition
stops spread from focus
no effect on seizure threshold
increases inactive state of voltage sensitive Na channels

acts using monohydroxy metabolite
Term
MOA carbamazepine
Definition
stops spread from focus
no effect on seizure threshold
decrease Na influx by prolonging inactive state
Term
MOA lamotrigene
Definition
increases inactivated Na channels
inhibits release of glutamate
Term
MOA phenytoin
Definition
decreases Na influx into neurons by prolonging active state
stabilizes neuronal membranes
reduces spread from focus
no effect on seizure threshold
Term
MOA valproic acid
Definition
increase inactivation of Na channels (at different site than phenytoin and carbamazepine)

reduces threshold Ca currents in thalamic neurons (weaker than ethosuxamide)

increases GABA inactivating GABA T-transaminase
Term
MOA zonlsamide
Definition
increases inactive state of Na channels
inhibits T type Ca channels
Term
MOA topiramate
Definition
relative to fructose
blocks Na channels
increases GABA actvity
blocks glutamate receptors
Term
MOA clonazepam
Definition
long acting BDZ
GABA CL ionophore complex
CIV
Term
MOA lorazepam
Definition
long acting BDZ
GABA CL ionophore complex
Term
MOA diazepam
Definition
long acting BDZ
GABA CL ionophore complex
Term
MoA primidone
Definition
relative to phenobarbital
same MOA but effective metabolites do work (phenobarbital, phenylethlmalonamide)
Term
MOA tigabine
Definition
blocks GABA uptake into presynaptic terminals
Term
MOA vigabine
Definition
irreversibly inhibit GABA transaminase
Term
MOA phenobarbital
Definition
enhance GABA inhibition
increase threashold for neuronal firing
inhibit spread of seizure activity from discrete focus
Term
MOA gabalentin
Definition
GABA analong increases synthesis and release
decreases glutamate and aspartate release
binds A2 subunit of voltage dependent Ca channels
Term
MOA levetfracetam
Definition
steroselective binding site in synaptic plasma membrane in CNS

inhibit firing without affecting mornal excitability prevents hypersynchronization of epileptiform burse firing and propogration of seizure activity

binds to specific synaptic protein SV2A that effects excitability
Term
MOA pragabalin
Definition
analong of GABA increases GABA synthesis and release (more potent than gabaentin)

decreases glutamate and aspratate release

blocks Na channels
Term
MOA acetazolamide
Definition
carbonic anhydrase inhibitor
Term
MOA ethosuximide
Definition
reduce low threshold T Ca currents in thalamic neurons
Term
which epilepsy drugs have a MOA that decreases Na influx (8)
Definition
oxycarbazepine
carbamazepine
lemtrigene
phenytoin
valproic acid
zonidamide
topiramate
pregabalin
Term
which epilepsy drugs have a MOA that acts through a metabolite or is a prodrug (2)
Definition
oxycarbamepine
primidone
Term
which epilepsy drugs stop spread from a focus (3)
Definition
oxycarbamepine
carbamepine
phenytoin
phenobarbital
levetfracetam
Term
which epilepsy drugs inhibit release of glutamate (4)
Definition
lamotrigene
topiramate
gabapentin
pregabalin
Term
which epilepsy drugs stabilize neuron membranes (3)
Definition
phenytoin
phenobarbitol - increase threshold
levetfracetam - inhibit firing wo affecting normal excitability, prevents hypersynchronization and propogation of seizure
Term
which epilepsy drugs reduce threshold of Ca currents (4), which type of channel
Definition
vaproic acid - at T channels in thalamic neurons
zonlsamide - at T channels in thalamic neurons
gabapentin - A2 subunit of voltage dependent Ca channels
ethosuxamide - at T channels in thalamic neurons
Term
which epilepy drugs interact with GABA (11), how
Definition
valproic acid - inactivate GABA T-transaminase
topiramate - increase GABA activity
clonazepam - GABA Cl ionophore complex
lorazepam - GABA Cl ionophore complex
diazepam - GABA Cl ionophore complex
primidone - enhance GABA inhibition
tigabine - block reuptake
vigabatrin - irreversibly inhibit GABA transaminase
phenobarbital - enhance inhibition
gabapentin - increase synthesis and release
pregabalin - increase synthesis and release
Term
which epilepsy drug blocks carbonhc anhydrase inhibition
Definition
acetazolamide
Term
SE oxycarbamazepine 6
Definition
dizzy, somomn, fatigue, coodrination difficulty

hyponatremia

30% cross hypersensitivty to carbamazepine
Term
SE carbamazepine 14
Definition
stupor, coma, resp depression, drowsiness, vertigo, ataxia, blurred vision

nausea, vomiting, hyponatremia, rash

aplastic anemia, agranulocytosis, thrombocytopenia

can induce serious liver disease (get function testing!)
Term
SE lamotrigine 3
Definition
benign rash
serious rash (esp in kids): SJS, toxic epidermal necrosis
Term
SE phenytoin 11
Definition
CNS depression: ataxia, behavior change, confusion, hallucinations, drowsiness

gingival hyperplasia

corse facial features in kids

histurism, GI upset, rash, lymphadenopathy, purple glove

anti-arrhythmic (dont stop abruptly)

interferes with B12 metabolism causing megaloblastic anemia

fetal hydnation syndrome (worse in 1st trimester) cleft lip/palate, congenital heart disease, slow growth, MR
Term
SE valproic acid 6
Definition
liver failure, pancreatitis, weight gain, insulin resistance

hyperammonemia encephalopathy (VHE)

hepatotoxic at theraputic doses by elevating enzymes esp in kids <2yo
Term
SE zonlsamide 9
Definition
dizzy, solumn, fatigue, coordination difficulty, psychosis

renal stones, weight loss, sweating,

teratogenic
Term
SE primidone 1
Definition
similar to phenobarbitol
Term
SE tigabine 1
Definition
porconvulsive effect can cause status epilepticus
Term
SE vigabatrin 1
Definition
permanent vision loss
Term
SE phenobarbital 6
Definition
good threshold between effective dose and CNS depression

kids: depresses cognative performance

sedation, ataxia, vertigo, morbiliform rash, CT disorders
Term
SE levetfracetam 5
Definition
dizzy, solumn, fatigue, coordination difficulty
caution with impaired renal flow/dialysis
Term
SE pragabalin 2
Definition
less fatigue that gabapentin
CV drug: some people feel high and report withdrawl symptoms
Term
SE acetazolamide 2
Definition
rapid tolerance
Term
SE ethosuxamide 5
Definition
drowsiness, nausea, vomiting, 10% eosinophilia, blood dysracias
Term
interactions with carbamazepine 6
Definition
metabolism initiation: cemetidine, diltiazem, erythromycin, isonizad, propoxyphene

never use in primary generalized seizure Na inhibition makes seizure worse
Term
interactions with phenytoin 10
Definition
inhibit phenytoin metabolism: dicumarol, cimetidine, sulfonamides, isoniazid

phenotyin increases P450: anti-epileptics, anti-coagulants, contraception, doxycycline, methodone, levodopa

stimulates phenytoin metabolism: carbamasepine

never use in primary generalized Na inhibition makes seizure worse
Term
interactions with zonisamide
Definition
decreases OC effectiveness
Term
interactoins with phenobarbital
Definition
drugs with hepatic metabolism, induces P450 enzymes
Term
interactions with gabapentin
Definition
none, able to use other AED
Term
phenytoin administaration, why
Definition
oral or IV
IM percipitates at site of injection
oral absorption is slow but complete in duodenum
Term
zonisamide metabolism and elimination
Definition
metabolized in liver
eliminated in kidney
Term
diazepam administration
Definition
IV for status epilepticus
Term
levetfracetam excretion
Definition
kidney
Term
phenytoin metabolism
Definition
90% metabolized by hepatic hydroxylation
Term
which epilepsy drugs can you use in pregnancy
Definition
phenytoin - supplement folate
Term
valproic acid metabolism
Definition
liver
Term
ethosuximide metabolism
Definition
liver
Term
which epilepsy drugs can be used for partial seizure 7
Definition
oxycarbazepine
lamotrigene
topiramate
vigabatrin
gabapentin
levetfracetam
pregabalin
Term
which epilepsy drugs can be used for neuralgia (3), which type
Definition
carbamasepine - trigeminal
gabapentin - neuropathic pain
pregabalin - peripherial
Term
which epilepsy drugs tx status epilepticus 4, which are DOC 2
Definition
phenytoin
lorazepam DOC
diazepam DOC
phenobarbital
Term
which epilepsy drugs tx absence seizure 3, which are DOC
Definition
valproic acid
acetazolamide - alt
ethozuximide - DOC
Term
which epilepsy drugs tx tonic / clonic seizure
Definition
valproic acid
Term
which epilepsy drug tx febrile seizure
Definition
phenobarbitol - DOC
Term
cause of epilepsy
Definition
firing of areas of neurons in brain (primary focus) which is anatomically normal

possibly inbalance of GABA: GABA transaminase elimase halts GABA to ensure balance in communication, if GABA is lacking it causes seizure
Term
what percipitates a seizure 5
Definition
change in blood gas, pH, electrolytes, glucose
increase in glutamate activity
Term
explain dual order kinetics
Definition
low blood levels: rate of metabolism proportional to blood level (1st order)

high blood levels: disporportional increase in concentration, steady state may not be reached before toxicity occurs (zero order kinetics) hepatic hydroxylation is filled up. makes t1/2 of drug meaningless
Term
define opiate
Definition
drug derived from opium (semisynthetic congers)
opium like
Term
define opioid
Definition
all agonist and antagonists natural and synthetic
morphine like
Term
define narcotic
Definition
strone opiate analgesic
often abused
not a pharmacological word
Term
define analgesia
Definition
loss of pein without LOC
Term
what is the ascending pain pathway
Definition
noxious stimuli > nociceptor > primary afferent neuron > dorsal horn > secondary neuron (spinothalamic) > supraspinal nuclei in thalamus > limbic system and primary somatosensory cortex
Term
what are the two types of primary afferent neurons / nocioceptors
Definition
somatic pain A delta (Ad) fibers
visceral pain C fibers
Term
somatic pain A delta (Ad) fibers: size, composition, speed, location
Definition
small
unmyelinated
fast, high threshold
terminate in laminae I
Term
somatic pain A delta (Ad) fibers: what do they sense, what do they cause
Definition
sense mechanical and thermal
cause sharp localized pain
Term
visceral pain C fibers: size, composition, speed, location
Definition
large
unmyelinated
slow
terminate in laminae II (substantia gelatinosa)
Term
visceral pain C fibers: what do they sense, what do they cause
Definition
sense: mechanical, thermal, chemical
cause: dull, diffuse, achine, burning pain
Term
how do affernt neurons work
Definition
release excitatory AA into dorsal horn (C fibers also release neuropeptides)
Term
describe the decending pain pathway
Definition
periaqueductal gray in midbrain and nuclei of rostroventral medulla > dorsal horn > NE/SE release > inhibit ascending pathway...

directly: direct synaptic inhibition
indirectly: activate inhibitory interneurons
Term
what are the three endogenous opioid peptides
Definition
enkephalins
endorphins
dynorphin
Term
general locations of enkephalins
Definition
in interneurons

pain areas, emotion areas, motor areas, antonomic reflex areas, inhibitory areas
Term
pain areas of enkephalins
Definition
laminae I and II, spinal trigeminal nuclei, PAG midbrain
Term
emotion areas of enkephalins
Definition
limbic system
Term
motor sreas of enkephalins
Definition
basal ganglia
Term
autonomic reflex areas of enkephalins
Definition
nucleus tractus solitaries
Term
inhibitory areas of enkephalins
Definition
dorsal horn causing inhibition of secondary ascending pain neurons
Term
locations of endorphins
Definition
hypothalamus, nucleus tractus solitaris
anterior pituitary: Co-release with ACTH in response to stress
Term
locations of dynorphin
Definition
mangocellylar cells of hypothalamus
posterior pituitary: role in fluid homeostasis
CNS: all over, esp laminae I and II
Term
explain how opioid receptors work
Definition
Gi protein coupled receptor > adenylate cyclase > cAMP > increases K and decreases Ca conductance > inhibits neuron activity
Term
what do opioids cause clinically to help pain
Definition
effect transmission of pain and pain perception (I feel it but I don't care)
Term
what are the classes of opioid receptors
Definition
Mu (m)
Kappa (k)
Delta (d)
65% homologous
Term
how do opioid analgesics work (the morphine model)
Definition
full agonist of Mu receptors
high doses interact with other opioid receptors
Term
12 CNS side effects of morphine
Definition
analgesia
euphoria
mood alteration
dec cough reflex in medulla
nausea/emetic: stimulation of chemoreceptor in postrema of medulla
sleep
increased ICP (NO use in trauma!!)
hypothalamus: alters temp equlibrium
neuroendocrine: dec testosteone and cortisol
miosis
convulsions at high dose (esp kids)
Term
explain how opioids effect the hypothalamus
Definition
alters temp equlibrium
acute: lowers
chronic: increases
Term
explain how opioids cause miosis
Definition
Mu and K agonists constrict pupil via parasympathetic
Term
what do opioids do to respiration (2)
Definition
decrease response to CO2 in brainstem decreasing respiration
CAUSES DEATH IN MORPHINE POISONING
max effect 5-10 min after IV administration

cough: decreases cough reflex in medulla
Term
what do opioids to do GI (8)
Definition
nausea/emetic: stimulation of chemoreceptor in postrema of medulla

stomach: Mu agonist dec HCl

Si: dec secretions, delay pooing, increase water absorption

LI: propulsive peristalsis stopped causing constipation

billiary: sphincter of oddi constricts and increases pressure and spasm in common bile duct

bladder: stops voiding reflex
Term
CV effects of opioids (2)
Definition
when standing causes histamine release leading to peripherial vasodilation and orthostatic hypotension
Term
effects of opioids in uterus (2)
Definition
prolong labor
respiratory depression in neonate
Term
effects of opioids in skin (1)
Definition
dilation of cutaneous vessels in flushing
Term
all opioids have tolerance, cross tolerance, and physical dependence. define each
Definition
tolerance: higher doses are needed to produce same response

cross tolerance: across all opioids

physical dependence: body adapts to presence of drug and requires it to function. termination causes withdrawl
Term
signs of withdrawl from opioids
Definition
pupil dilation
hyperventilation
diarrhea
dysphoria
Term
interactions with opioids (3)
Definition
MAOI: hyperpyrexic coma

sedative/hypnotics: increased CNS depression, respiratory depression

TCA/anti-psych: increased sedation, increased respiratory depression
Term
in order from least to most effective list the 9 pain killers less effective than morphine
Definition
diphenyloxylate D
dextropropoxyphene 1/20
pentazocine 1/15
codine 1/12
tramadolol 1/12
mepheridine 1/10
hydrocodone 1/13
oxycothinin 2/3
oxycodone 2/3
Term
what are the two drugs that have the same effectiveness as morphine
Definition
methadone
nalbuphine
Term
what are the 6 drugs more effective than morphine from least to most potent
Definition
diacetylmorphine 3-5x
butorphanol 5x
hydromorphone 7x
buprenophine 20-50x
fentynil 80x
sufentanil 800x
Term
what are the two "other" pain killers from least to most potent
Definition
diphenyloxylate
tramadolol
Term
what are the 5 codine/codine derivative pain killers from least to most potent
Definition
dextropropoxyphene
codine
hydrocodone
oxycotinin
oxycodon
Term
what are the 4 mixed pain killers from least to most potent
Definition
pentazocine
nalbuphine
butorphanol
buprenophine
Term
what are the 7 opioid pain killers from least to most potent
Definition
mepheridine
methadone
morphine
diacetylmorphine
hydromorphone
fentynil
sufentanil
Term
which pain killers cannot be taken oral (7)
Definition
morphine* can but it sucks
nalbuphine
diacetylmorphine
butorphanol
buprenophine
fentynil
sufentanil
Term
what painkillers stronger than morphine or equal to can be taken oral (2)
Definition
morphine* but it sucks
hydromorphone
Term
what painkillers can be taken IV IM (9)
Definition
mepheridine
methadone
morphine
nalbuphine
butorphanol
hydromorphone
buprenophine
fentinyl
sufentanil
Term
which pain killers can be taken SC (3)
Definition
morphine
nalbuphine
hydromorphone
Term
what painkiller can be taken nasal
Definition
butorphanol
Term
what painkiller can be taken rectal
Definition
morphine
Term
what pain killer can be taken sublingual
Definition
buprenophine
Term
what pain killer can be taken transdermal/transmucosal
Definition
fentynil
Term
which pain killers have a different metabolism, describe it (4)
Definition
codine: 10% converted to morphine

mepheridine: metabolized via N-demythylation to normepheridine

morphine: conjugated with glycorinic A to make morphine 6, excreted as morphine 3

diacetylmorphine: hydrolyzed to 6-monoacetylmorphine (lipid soluble), hydrolyzed to morphine
Term
MOA of the mixed opioids (4)
Definition
pentazocine: partial Mu antagonist, K agonist

nalbuphine: strone K agonist, Mu antagonist

butorphanol: strong K agonist, Mu antagonist

buprenophinel: strong K agonist, Mu antagonist
Term
MOA tramadolol
Definition
inhibit NE/SE
weak Mu agonist
Term
MOA oxycotinin
Definition
oxycodone time release in higher doses
Term
which painkillers have a long duration (2)
Definition
methadone
buprenophine
Term
what pain killer has a rapid onset and short duration
Definition
fentynil
Term
unique SE of dextropropxyphene
Definition
not analgesic
not addictive
low toxicity
supresses CNS
Term
unique use of dextropropxyphene
Definition
antitussive: cough supression
Term
unique SE of pentazocine
Definition
high dose increases catecholamines and thus BP
Term
unique use of pentazocine
Definition
help with withdrawl, releave some pain
Term
unique use of codine
Definition
often combined with ASA/APAP, NSAID
antitussive
Term
unique SE of tramdolol
Definition
analgesia not completely reversed by antagonist
seizure - never in epileptic!!
little respiratory depression
interacts with SSRI!!
Term
use of tramdolol
Definition
mild and moderate pain
Term
unique SE of mepheridine
Definition
no CV/pupil effects when oral
metabolite cause tremor, twitch, convulsions
EVEN THOUGH ALL SHOULDNT GO WITH MAOI, THIS ONE REALLY SHOULDENT
Term
unique use of mepheridine
Definition
ok for delivery
Term
unique use of hydrocodone
Definition
often combined with ASA/APAP, ibprofen
Term
unique use of oxycotinin
Definition
often combined with ASA/APAP
Term
unique SE of methadone
Definition
increased euphoria
Term
unique use of methadone
Definition
help with withdrawl (because it has a more mild one)
Term
unique SE nalbuphine
Definition
low abuse
depresses respiration
Term
unique SE diacetylmorphine
Definition
fast euphoria due to lipid solubility
Term
unique SE butorphanol
Definition
increased workload on heart
Term
unique use of butorphanol
Definition
not good for chronic pain, acute only
Term
unique SE buprenophine
Definition
less respiratory depression
Term
uniquse use buprenophine
Definition
added to naltrexone to make auboxone to maintain opioid dependent pt
Term
unique SE fentynil
Definition
interaction with deoperidol (neuroleptic anesthesia)
Term
unique use fentynil
Definition
IV during anasthesia
Term
unique SE sufentanil
Definition
no CV effects
Term
which pain killers are used for cough supression
Definition
dextropropoxyphene
codine
Term
what pain killers are used to help with withdrawl (3)
Definition
pentazocine
methadone
buprenophine
Term
what pain killers are often combined with ASA/APAP, of other mild pain killer
Definition
codine
hydrocodone
oxycotinin
Term
what are the 4 opioid antagonists
Definition
naloxone
naltrexone
nalmefene
methylabaktrexibe
Term
naloxone: administration, duration, distribution
Definition
IV, IM, SC
duration 1-4h
completely metabolized 1st pass
Term
use naloxone
Definition
tx opioid dependency and toxicity
Term
naltrexone: administration, duration
Definition
oral
24h
Term
naltrexone use
Definition
opioid toxicity and dependence
alcoholism
Term
nalmefene: administration, use
Definition
IV
pure opioid antagonist (best) for tx opioid dependency and toxicity
Term
methylabaktrexible: administration, distribution and SE
Definition
SC
unable to cross BBB so no pain killing
Term
use methylabaktrexible
Definition
prevent morphine constipation
Term
what is the restriction of all opioid antagonists
Definition
no opioid, no effect
Term
what is the story used for pain killers less than morphine
Definition
i died from phenyl
dex tried to operate
he penetrated
the code in my
tramp stamp
me phrend the dean
stole my hydrocodone
oxycotinin
and oxycodone
Term
what is the story used for paiin killers same sa morphine
Definition
meth done
morphed into a
nail biting pheind
Term
what is the story used for pain killers more than morphine
Definition
heroine
butt and or oral
hydrates me
but phrends no me
fender
suffers
Term
how is serotonin made and broken down
Definition
L tryptophan ingested >
facillitated transport into brain (concentration in blood relation to other AA)>
RATE LIMITING: tryptophan hydroxylase + O2 + pteridine >
serotonin >
MAO >
5-hydroxyindole acetic acid >
transport out of brain (inhibited by probenecid) >
small amt in urine (unless malignant carcinoid)
Term
what are the 4 serotonin receptors how do they work, where are they located
Definition
all 16 in brain, not all in body

1: Gi: inc K, hyperpolarize, inhibit
2: Gq: dec K, depolarize, excite
3: ion: dec K, inc Na, depolarize (fast)
4: dec K, hyperpolarize, excite
Term
functions of serotnin in blood and vessels 2
Definition
platelets contact endothelium which releases 5HT which goes to 5HT2 on platelets causing aggregation and vasoconstriction

vasoconstriction in eplanchnic, renal, pulmonary, cerebral)
Term
functions of serotonin in lungs 2
Definition
pulmonary vessel constriction

constriction of bronchioles
Term
functions of serotonin in GI
Definition
enterochromaffin cells make it, store it, and use it.
released bia vagal stimulation to cause emesis
Term
functions of serotonin in CNS 9
Definition
sleep, cognotion, sensory, motor, temp, pain, appetite, sex, hormone secetion
Term
is serotonin hydrophillic or phobic what does this mean about its distribution and function
Definition
phillic
cannot cross BBB, must be made in brain

not all cells that use it make it so they need transporter
Term
why can serotonin be hallucinogenic
Definition
N and O methylated properities
Term
what is the chemical class of serotonin
Definition
indolealkyamines
Term
what compound is relative to serotonin, how is it foemed
Definition
melatonin
N acetylation
O methylation
in pineal gland controlled by light
Term
ergot: where does it come from, what does it to (biochem and physio)
Definition
fungus on rye and grain

interacts with 5HT, D, and a receptors different interaction in different systems

vasoconstriction, cerebral constriction, supress sensory neuropeptides
Term
complication of all ergots
Definition
vasoconstriction can cause gangrene and misscarriage
Term
migraine: family hx, sex, onset, location, character, duration, associated symptoms
Definition
hx: yes
sex: females
onset: variable
location: usually unilateral
character: pulse, throb
duration; 2-72h
symp: aura (15%), photosensitive, sound sensitive, pale, nausea, vomiting. aggrevated by physical activity
Term
cluster headache: family hx, sex, onset, location, character, duration, associated symptoms
Definition
hx: no
sex: males
onset: in sleep
location: behind/around eye
character: sharp, steady
duration: 15-90min
symp: uni/bilateral sweating, flushing, congestion, ptosis, lacrimation, pupillary changes
Term
tension headahce: family hx, sex, onset, location, character, duration, associated symptoms
Definition
hx: yes
sex: females
onset: stress
location: bilateral around head
character: dull, persistant, tight
duration: 30 mim - 7d
symp: mild photophobia, noise phobia, anorexia
Term
mild migraine: definition, tx
Definition
occasional throbbing, no major impairment

mild analegesics combo analegesics, amiemetics
Term
moderate migraine: definition, tx
Definition
some impairment in function, nausea

combination anaglesics, ergots, sumatriptan, amiemetics
Term
severe migraine: definition, tx
Definition
>3/mo, functional impairment, nausea, vomiting

ergot, sumatriptan, animetics, prophylaxis
Term
what drugs are used in migraine prophylaxis 5, what is #1
Definition
#1 B blocker
Ca channel blocker
TCA
serotonergic agonist
MAOI
Term
what B blocker are used in migraine prophylaxis 5
Definition
propranolol
timolol
atenolol
nadolol
metoprolol
Term
what TCA are used in migraine prophylaxis 2
Definition
amitriptyline
nortryptyline
Term
what serotonergic agonist are used in migraine prophylaxis 2
Definition
methylserglide
cyproheptadine
Term
what MAOI are used in migraine prophylaxis 2
Definition
phenlzine
isocarboxazide
Term
what are triggers someone can avoid for migraine
Definition
alcohol, foods, irregular sleep, stress, time zone shift, altitude, barometric pressure, menstural cycle
Term
SSRIs (6), uses (5)
Definition
citalopram
paroxetine
sertaline
fluoxetine
fluboxamine
escitalopram

depression, PMDD, OCD, anxiety, migrane prophylaxis
Term
serotoniin agonists and their receptors (3)
Definition
sumatriptan: 5HT-1D
LSD: 5HT-2A, 2C
buspirone: 5HT-1A
Term
serotonin antagonist and their receptors:
Definition
odansteron: 5HT-3
risperidone: 5HT- 2A, 2C, D
cyproheptadine: 5HT-2A
methysergide: 5HT-2A, 2C
Term
ergots 6
Definition
ergoloid methylate
ergonovine
ergotamine
bromocryptine
methysergide
dihydroergotamine
Term
MOA sumatriptan 2
Definition
constrict vessels
supress release of neuropeptides
Term
MOA LSD
Definition
non selective
ergot derivative
Term
MOA buspirone
Definition
K channel open, hyperpolarization, inhibitory
Term
MOA cyproheptadine
Definition
inhibit 5HT-2A on smooth muscle
Term
MOA methysergide 2
Definition
LSD and methylergovine relative

inhibits vasoconstriction and vasopressin
inhibits 5HT-2A, 2C on smooth muscle
Term
SE sumatriptan
Definition
IV causes coronary spasm
Term
SE LSD
Definition
psychic alterations
hallucinations
Term
SE buspirone
Definition
headache, dizzy
Term
SE risperidone
Definition
gynecomastia: D receptor inhibition allows activity of prolactin
Term
MOA methysergide
Definition
inflammatory fibrosis (esp heart) in prolonged tx
Term
administration sumatriptan 3
Definition
IV - NO causes coronary vasospasm
oral - poor absorption
SC
nasal
Term
administration odansteron 2
Definition
IV, oral
Term
administration methysergide
Definition
stop for 3 wk every 6 mo
Term
use sumatryptan
Definition
acute migraine attacks
Term
use LSD
Definition
fun
Term
use buspirone
Definition
chronic anxiety
Term
use odansetron (MOA too)
Definition
nausea and vomiting (esp from chemo due to enterochromaffin release of 5HT in SI stimulation emesis

vagal afferents through 5HT-3 receptors initiate vomiting, this is stopped
Term
use of cyproheptadine 2
Definition
migraine prophylaxis
counteract sex SE of SSRI
Term
use methysergide 5
Definition
migraine prophylaxis
vascular headache prophylaxis
depression
schizophrenia
Term
use risperdone 3
Definition
migraine
depression
schizophrenia
Term
MOA ergoloid methylate
Definition
increase brain metabolism
Term
MOA ergonobine
Definition
increase strength, duration, and frequency of uterine contraction to decrease uterine bleeding
Term
use ergoloid methylate
Definition
early onset alzheimers
Term
use ergonovine
Definition
post partum hemorrhage
abortion bleeding control
Term
MOA ergotamine
Definition
caffiene + belladonna + phenobarbitol
Term
MOA bromocryptine
Definition
D2 agonist
Term
MOA methysergide 2
Definition
ergot derivative
inhibit vasoconstriction and vasopressin
inhibit 5HT action on smooth muscle
Term
MOA dihydroergotamine
Definition
caffiene + belladonna + phenobarbitol
Term
administration ergotamine
Definition
PO, SL, retro rocks

should not exceede 6mg/d or 10mg/wk
take 1-2mh/0,5h until relief
Term
administration of dihydroergotamine
Definition
IM, nasal
Term
SE ergotamine
Definition
CP, coronary vasoconstriction, tachy, brady

numbness, tingling of fingers and toes

nausea, vomiting
Term
contraindications of ergotamine 4
Definition
pregnancy, peripherial vascular disease, hepatic/renal impairment
Term
contraindications of dihydroergotamine 4
Definition
pregnancy, peripherial vascular disease, hepatic/renal impairment
Term
interactions of ergotamine 4
Definition
azithro, dirithro, clathro, erythromycin causes ergotism (HTN, ischemia)
Term
interactions of dihydroergotamine 4
Definition
azithro, dirithro, clathro, erythromycin causes ergotism (HTN, ischemia)
Term
use ergotamine 2
Definition
acute migraine or cluser headache
Term
use dihydroergotamine 2
Definition
migraine or cluster headache
Term
what is the most common supraventricular arrhythmia
Definition
PAC
Term
describe EKG in premature atrial contraction, cause
Definition
until early P wave/ORS (hides normal P in it) followed by pick back up of sinus
SA node is resetting
Term
TX PAC 3
Definition
asymptomatic- none
BB, type Ic
Term
describe EKG in premature junctional complex, cause
Definition
sinus rhythm followed by premature abnormal P wave (upside down or hidden) and QRS with wide S

complex originates from AV node/His
Term
Tx premature junctional complex 2
Definition
BB
type IC anti arrhythmics
Term
cause of physiological sinus tachycardia 5
Definition
pain, exercise, fever, anxiety, hypotension, anemia
Term
cause of inappropirate sinus tachycardia
Definition
increase HR with normal activity due to SNS increase, PNS decrease, viral illness causing autonomic dysutonomia
Term
signs of inappropirate sinus tachycardia
Definition
palpitations, CP, GI upset, syncope
Term
TX inappropirate sinus tachycardia 2
Definition
asymptomatic - none
BB
Term
describe the EKG for AFib
Definition
irregular irregular
rapid ventricles 120-160, atria 500
fine fibrillations of P waves with irregular random QRS
Term
physiology of AFib, complications
Definition
atria automaticity and reentry mostly at atria and pulmonary veins

blood pools and clots in atria apendages and causes thrombus and stroke
Term
causes of AFib 6
Definition
acute hyperthyroid
acute alcohol/drugs
post-op
coronary disease
SVA - AV reentry
increases with age 5%>75yo
Term
signs of AFib 6
Definition
asymptomatic
fatigue
SOB
syncope
exercise intolerance
palpitations/angina
Term
risk factors for stroke 8
Definition
valve disease
mechanical valve
previous thromboembolism
heart failure
systole dysfunction
HTN
DM
age
Term
explain the CHAD2 score scoring and what treatment it correlates with
Definition
CHF, HTN, DM, >75yo = 1
previous stroke/TIA = 2

0= no therapy / aspirin
1= aspirin / warfarin
2 = warfarin / thrombin inhibitor
Term
what drug is a trombin inhibitor
Definition
clopdegril
Term
how is asymptomatic AFib treated
Definition
if <100BPM then give anticoag according to CHAD2

if >100bph then try BB, CCB, digoxin. if this dosent work try antiarrhythmic...
A: if has CAD then amioderone, soditol, dofetilide
B: if has LV dysfunction, tachy, cardomyopathy then use limited soditol
C: if has LVH/HTN then use fleconide or class 1C

if this dosent work ablate
Term
how is symptomatic stable AFib treated
Definition
IV heparin +
amiodorine, drocamamide, or dofetilide ibuilid

maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide

if this dosent work ablate
Term
how is symptomatic unstable AFib treated
Definition
IV heparin
TEE if >24h
synch cardiovert biphasic 200J

maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide

if dosent work ablate
Term
when do you ablate, 3 types
Definition
when all TX dosent work
when LV problems occur

focus: ablate near pulmonary veins

AV: eliminate and put in pace maker

coxmaze: ablate all reentry spots
Term
describe an EKG in AFlutter / microreentrant atrial tachycardia
Definition
regular irregular
atria 200-300
ventricles 130-150
less tolerated than AFib

spiked P waves with regular ventricle contraction between many
Term
descirbe a multifocal atrial tachycardia EKG
Definition
P waves with at least 3 different morphlogies
Term
cause of multifocal atrial tachycardia 2
Definition
pulmonary or septic infection
Term
TX multifocal atrial tachycardia 2
Definition
tx illness
CCB
Term
what do you never use in multifocal atrial tachycardia 4
Definition
BB
amioderone
flecinide
propefanone
Term
what does a AV reentry tachycardia / proxysmal supraventricular tachycardia look like, cause
Definition
rate 150-250
atria and vantricles both contract
retrograde P waves

AV node has two pathways: 1 slow, 1 fast. current goes doen slow and up fast
Term
cause PST
Definition
teens - 30s
alcohol, drugs, excitement
no underlying heart disease
Term
prevention of PST 3
Definition
avoid trigger
ablation
B/Ca blocker
Term
TX PST 3
Definition
1. vasovagal
2. IV adensine or IV class IV
3. maintience: CCB, BB, digoxin
Term
what does an accelerated junctional rhythm EKG look like, cause
Definition
50-99
depolarization near the AV node or on it
abnormal P waves or none
Term
cause accelerated junctional rhythm 2
Definition
digitoxin toxicity
ablation of SA
Term
TX accelerated junctional rhythm 3
Definition
correct toicity
class 1A or 1C
Term
causes or arrhythmia 7
Definition
Hypoxia- copd
Ischemia + irritability
Sympathetic
Drugs- BB, digoxin, cocaine
Electrolyte- dec K, inc Ca
Brady/tachy
Stretch- LVH/HTN
Term
explain the ion movements in the 4 phases of cardiac muscle contraction
Definition
4. K leaks out
0: Na rush in
1: Na slows, K rush out
2: K rush out, Ca rush in
3: K rush out
4: K leaks slowly
Term
explain the state of the Na gates in cardiac muscle contraction
Definition
4: resting - resting
0: M gates open - open
1: H gates close - absolute/effective refractory, inactive
2: absolute/effective refractry
3: switches mid phase to relative refractory
4: resting
Term
explain the ion movements in the phases of SA/AV contraction
Definition
4: Na leaks slowly in
0: Ca rushes in
3: K rushes out
4: Na leaks in
Term
explain how to read the boxes on EKG
Definition
1 little = 0.04s
1 big = 0.2 sec, 0.5mV

2 big = 1mV
5 big = 1 sec

30 big = 6 sec
# peaks x 10 = rate
Term
define sinus pause
Definition
stops for >1 beat (3 sec is ok in athlete)
Term
define sinus exit block
Definition
stops for 1 beat
Term
define sick sinus
Definition
brady/tachy alternating
Term
define state dependent
Definition
channel blocking dosent work well in resting (4)
Term
what causes DAD 4
Definition
Ca overload
SNS
digitoxin
MI
Term
what causes EAD
Definition
dec HR
de K
prolonged 3
prolonged QT
Term
what can EAD lead to
Definition
torsades
Term
what are the three conditions needed for reentry
Definition
1. obsticle
2. unidirectional block
3. long enough to outlast refractory
Term
why are reentrys scary for pt
Definition
AFib will be accelerated if it happens and cause m ore deterioration
Term
how does a WPW EKG look
Definition
PR>0.12
wide QRS
D waves in some leads
consistantly abnormal P waves
Term
what pathway does WPW take
Definition
bundle of kent
Term
what pathway does lown ganong levine take
Definition
james fiber (intranodal)
Term
what does lown ganong levine EKG look like
Definition
PR<0.12, normal QRS
Term
how is a reentry treated 4
Definition
vasovagal
IV adenosine or diltzem
maintience: BB, CCB, digoxin, fleccanide, procamide
Term
how is a person with reentry in AFib treated
Definition
1. cardiovert
2. procanamide, ibutalide, amioderone
Term
what does a 1st deg AV block look like
Definition
slowed conduction through node and tissue
common, asymptomatic, PR>200ms
Term
what does a mobitz type 1 (wenchebach) look like
Definition
usually benign
block on or by node
progressive lengthening of PR until one is dripped
Term
what does a mobitz type II look like
Definition
block below AV node can progress to 3rd deg
may need pacemaker
consistant PR interval until one is dropped
Term
what does a 3rd deg AV block look like
Definition
AV dissociation, ventricles and atrial are independent
block at AV, upper BB, lower BB
ventricles 30-45
atria 60-100
Term
causes of AV block 4
Definition
autnomic- vasovagal
lyme, chagas, sphyilis
metabolic: ince K, dec adrenal
drugs: digoxin, CCB, adenosine
Term
TX AV block
Definition
type 1: none or atropine/epi/amnioderone

type 2: atropine/eip/amnioderone

type 3: atropine/epi/amnioderone or pacemaker
Term
what does a EKG for premature ventricular complex look like, cause
Definition
normal sinus with an out of place wide QRS, hides P wave
comes from purkinje
compensatory pause
Term
3 types of PVC
Definition
bigeminy: sinus/PVC/sinus/PVC/snus
tigeminy: sinus/sinus/PVC/sinus/sinus/PVC
pair/couple: sinus/PVC/PVC/sinus/PVC/PVC/sinus
Term
what increases risk of PVC 3
Definition
age
heart disease
Term
what should you NEVER take with a PVC
Definition
antiarrhythmics = DEATH prolong QT
Term
what is a complication of PVC
Definition
VTach
Term
tx PVC 2
Definition
asymp- nothing
symp- BB, K channel blocker
Term
describe the 2 kinds of VTach EKG
Definition
monomorphic: large repeating, regular QRS
polymorphic: oscilating sizes of QRS
Term
cause VTach
Definition
origin below bundle of His sustained
Term
2 classificationsof VTac
Definition
sustained: >30sec, >3PVC
nonsustained: <30sec
Term
what drugs should you NEVER use in VTach 2
Definition
verapmil
adenosine
Term
how is someone who is stable with VTach tx
Definition
satolol
amoderone
phenytoin
lidocaine - MI
propafenene

cardiovert - synch

maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol
Term
how is someone who is unstable with VTach tx
Definition
cardiovert

maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol`
Term
describe the 2 EKG types for VFib
Definition
coarse: spiky fibrillations
fine: small fibrillations
Term
VFib: 2 types, tx, effect in blood
Definition
no CO
primary: no CHF
secondary: with CHF
TX: asnch cardiovert
Term
what is the cause of long QT syndrome
Definition
defect in cardiac ion channel causing repolarization and prolonged plateau
Term
TX prolonged QT syndrome
Definition
implant defiv ig hx arrahytmic or syncope
avoid long QT drugs
Term
drugs with long QT
Definition
erythromycin
clathromycin
procanamide
quinidine
flecanide
sotalol
amioderone
Term
signs of tachycardia
Definition
syncope
CP dizzy
dyspnea
Term
evaluation of tachycardia
Definition
EKG
24h holder
telemetry
electrophysiolgy
ECHO stress test
Term
causes of bradhycardia
Definition
autonimic dysruption
sick sinus syndrome
hypothyroid
hypotension
hypothremia
physiological - athlete
inflammatory - pericarditis
structural heart disease - CAD
vasovagal
BB
CCB
digoxin
lithium
methadone
K channel blocker
Term
MOA class 1 drugs
Definition
block Na channels in abnormal high frequency rhythms
affinity for open/inactive channels
Term
MOA of class 1 A-C, half life
Definition
A: N and K block, 1-10sec. increase ERP, supress 0

B: Na block. decrease ERP, increase ) slope.

C: Na, Ca, K blocker. depress slope 0, decrease max depolarization
Term
explain how the class 1A-C graph looks
Definition
A: lengthens 0 slope, lower plateu height, elongated 3

B: lengthens 0 slope less than A, shortens 3

C: lengthens 0 slope most, shortens plateau height
Term
class 1A drugs 3
Definition
quinidine
procanamde
disopyramide
Term
class 1B drugs 3
Definition
lidocaine
mexiletine
phenytoin
Term
class 1C drugs 3
Definition
flecanide
propafenone
Term
class 2 MOA
Definition
B adrenergic agonist
lengthen (decrease) slope of 0 and 4 (shift right)

decrease automaticity at SA, HR, CO
lengthen PR
Term
what drugs decrease mortality in arrhythmia pt
Definition
B blockers
Term
4 B blockers used for arrhythmia and when
Definition
propanolol, atenolol, metoprolol: decrease sudden cardiac death after MI arrhythmia

esmolol: shor tacting, IV acute arrhythmia
Term
why is esmolol short acting
Definition
metabolized by RBC t1/2 9 min
Term
MOA Class 3 drugs
Definition
K channel blockers
elongaed ERP
Term
class 3 drugs 5
Definition
sotalol
amiodarone
dronedarone
dofetilide
ibutilid
Term
class 4 drugs MOA
Definition
Ca channel blockers
increase slow of 0, elongate ERP
increase AV.SA conduction

block inactive and active Ca channels mostly at SA/AV node
increase PR due to AV delay
Term
2 CCB
Definition
verapamil
ditazem
Term
dofetilide/ibutilid: administration, use, SE
Definition
IV acute
NOT for long duration AFib/Flutter they dont respond
SE torsades

USE: drug cardiovert in WTD arrhythmia, AFib, AFlut
Term
amiodarone, dronedarone MOA
Definition
blocks Na, Ca, K
increases QRS, PR, QT
Term
SE amniodarone, droendarone
Definition
sinus brady
PULMONARY ACEOLITIS/FIBROSIS
hepatotoxicity
photosensitivity
thyroiditis/blue skin- amioderone
Term
use: amniorarone, droendarone
Definition
ANY supraventricular tachycardia drug cardiovert: AFib/flut (ok with CAD), VTac, AV Block, WPW tachyarrhythmia
Term
sotaolol MOA
Definition
prolong QT
ERP prolong
B blocker dec SA automaticity
Term
SE sataolol
Definition
EAD
bradycardia
dyspnea
fatigue
torsades
Term
USE satalol
Definition
MOST MI
maintance post-VTach
drug cardiovert- VTach, LV dysfunction and CAD asymp AFib/Flut
Term
quinidine: MOA
Definition
antimalaria
anti-M inc HR
a1 blocker dec HR and cause hypotension and long PR
widen QRS and QT
Term
SE quinidine
Definition
mortality in non life threat arrhythmia
hypertension
vertigo
tinnutis
headache diarrhea
torsades
AFib/flutter (due to dec K)
hypokalemia
Term
procanamide MOA
Definition
shorted t1/2
acetylated to NAPA which blocks K
Term
SE procanamide
Definition
mortality in non-life threat arrhythmia
hypotension
lupus like due to NAPA acetylation
torsades (hypokalemia)
Term
disopyramide: administration, MOA
Definition
oral
anti-M dec HR
decrease PR interval
Term
disopyramide SE
Definition
mortality in non life threat arrhythmia
hypotension
glaucoma
dry mouth
urinary retention
constipation
torsades
Term
MOA lidocaine
Definition
local anastetic decreases automaticity in purkinje blocking NA
Term
lidocaine administration and exretion
Definition
IV high first pass
eliminated in liver
Term
SE lidocaine
Definition
drowsiness
slurred speech
confusion
convlusions
Term
administration and MOA mexiletine
Definition
oral lidocaine
Term
SE mexiletine
Definition
tremor, nausea
Term
MOA phenytoin
Definition
anticonvulsant
blocks NA and purkinke
Term
SE phenytoin
Definition
vertigo confusion, gingival hyperplasia
P450 inducer
Term
MOA flecanide
Definition
effects normal heart
prolongs AP in atria and ventricles
inc PR, QRS, QT
Term
SE flecanide
Definition
mortality in ventricle arrhythmia
blurred vision
dizzy
headache
Term
MOA propafenone
Definition
flecanide for life threatning ventricular arrhythmias
Term
SE proparfenone
Definition
increased mortality in non life threating arrhythmia
Term
use quinidine
Definition
accelerated junctional rhythm
maintience VTach/VFib
maintience AFib/Flut
Term
use procanamide
Definition
accelerated junctional rhythm
drug cardiovert WPW arrhythmia
maintain WPW
Term
use disopyramide
Definition
accelerated junctional rhythm
maintain AFib/Flut
maintain VFib/Tach
drug cardiovert WPW arrhythmia
Term
use lidocaine
Definition
chem cardiovert VTach/Fib MI
Term
use melixetine
Definition
maintain aftr VTach/Fib MI
Term
use phenytoin
Definition
maintain aftr VTach/Fib MI
chem cardiovert VTach/Fib MI
Term
use of class 1C
Definition
premature atrial contraction
junctional premature complex
not responding asymptomatic AFib/Flutter with HTN/LVH
accelerated junctional rhythm
proprafenone: cardiovert VTach/Fib
Term
use of BB
Definition
prematyre atrial contraction
junctional premature complex
inappropirate sinus tachycardia
maintain AFib/Flut
maintain PST/AV reentry
dec symp ot PVC
maintain WOW
Term
use of CCB
Definition
maintain AFib/Flut
multifocal atrial tachycardia
PST/AV reentry
maintain WPW
Term
MOA digoxin
Definition
increase aytomaticity
increase refractory in opurkinjue
decrease refractory in ventricles and atria
parasympathetic via vagus increases PR and and dec conduction
Term
SE digoxin
Definition
increased CA and automaticity causes DAD
extra systole
tachycardia
PVC
fibrillation
visual changes (yellow)
Term
use digoxin
Definition
maintain AFib/Flut
maintain PST
maintain WPW
VTACH PROPHYLAXIS
Term
MOA adenosine
Definition
high dose activates Gi decreasing Ca current decreasing conduction velocity increasing ERP decreasing AV velocity
t1/2 8sec must be IV bolus
Term
SE adenosine
Definition
flushing, CP, hypotension
Term
use adenosine
Definition
DOC IV bolus supraventricular tachycardia
PST/AV reentry
WPW
Term
MOA K ions
Definition
decrease ectopic pacemakers
esp from digitalis
Term
SE K ions
Definition
reentry arrhythmias
Term
MOA Mg ions
Definition
stops digitalis arrhythmia and torsades
Term
what is the general order for tx htn 12
Definition
thiazide diruetic
ACE inhibitor / ARB
CCB
BB
other: renin inhibitor, ALD receptor antagonist, a1 adrenergic blocker, a2 agonist, peripherial adrenergic blockers, non-specific adrenergic blockers, vasodilators
Term
what is the general order for tx of CHF 10
Definition
ACEI/ARB
BB: metaprolol, bisprolol
Non-specific BB: carvedilol
amlodipiine
hydralazine
inotropic: B agonist, phosphodiesterase inhibitor, nesiritide, digitalis
Term
explain the theatment of eldelry of AA with HTN 2
Definition
thiazide
CCB
other
Term
explain the TX of HTN post MI 2
Definition
24h: ACEI
maintain: ARB, BB
Term
explain the TX of HTN in pt with renal failure 1
Definition
ACEI/ARB
Term
explain TX of HTN in pt with DM 1
Definition
ACEI/ARB
Term
explain TX of HTN in pregnant pt
Definition
mehyldopa
Term
explain TX of HTN in pt with renal HTN
Definition
clonidine
Term
what is #1 and #2 choice for acute HTN
Definition
1. sodium nutroprusside
2. non-specific adrenergic blockers (labelalol, carvedilol)
Term
explain TX of HTN in pt with asthma or peripherial vascular disease
Definition
CCB
Term
what HTN drugs can tx diabetic nephropathy 2
Definition
ACEI, ARB
Term
ther than HTN what can BB treat 4
Definition
hyperthyroid
migraine prophylaxia
glaucoma
cardiomyopathy
Term
other than HTN what can a1 adrenergic blocker tx
Definition
BPH
Term
what than HTN what vasodilator has another use, what is it
Definition
minoxidil: topical male pattern baldness
Term
what drug do you use in CHF renal failure pt (#1 and #2)
Definition
DOC: ACEI/ARB
2: hydralazine
Term
2 thiazide diruetics
Definition
chlorthalidone
hydrochlorothiazide
Term
3 ACEI
Definition
catopril
lisinopril
-pril
Term
2 ARN (ANGII receptor blocker)
Definition
losartin
-sartin
Term
3 CCB, which can be used for CHF
Definition
verapamil
diatiazem
amlodipine - CHF and HTN
Term
explain naming of BB, which can be used in CHF
Definition
A-M B1 selective -olol
N-Z B1/2 non-selective -olol
metapropolol
bispropolol
Term
1 renin inhibitor
Definition
aliskirein
Term
2 ALD receptor antagonist
Definition
spironolactone
eplerenone
Term
2 a1 adrenergic blockers
Definition
prazosin
terazosin
doxazosin
Term
2 a2 agonist
Definition
clonidine
methyldopa
Term
1 peripherial adrenergic blocker
Definition
risperidine
Term
2 non-specific adrenergic blockers, which is used in CHF
Definition
labetalol
carvedilol - CHF and HTN
Term
4 vasodilators, which can be used for CHF
Definition
hydralazine - CHF and HTN
minoxidil
Na nitroprusside
isorbide dinitrate
Term
4 categories of inotropic drugs
Definition
B adrenergic antagonist
phosphodiesterase inhibitor
nesiritide
digitalis
Term
1 B adrenergic antagonist
Definition
dobutamine
dopamine
Term
2 phosphodiesterase inhibitor
Definition
inamirone
milrione
Term
what is nesiritide made of
Definition
recombinant human BNP
Term
2 tyes of digitalis
Definition
digoxin
digitoxin
Term
MOA thiazide diruetic
Definition
stops electrolyte transport causing Na/water excretion

decreases BV, CO and BO
increases urine output

urineoutput, CO, and BV return to normal in days but BP stays fixed due to vascular reactivity to NE and secreased structural resistance

overall: DECREASES PRELOAD
Term
MOA ACEI
Definition
stops conversion of ANGI to ANGII and bradyinin to inactive

causes vasodilation: inc preload and afterload
water/NA excretion: dec preload
prevents ALD cardiac remodel

stops renin feedback and renin builds up
Term
MOA ARB
Definition
stops ATI receptors so ANGII can't activate ALD or vasoconstrict

vasodilation: dec preload and afterload
water/Na excretion: dec preload
stops cardiac remodeling
Term
MOA verapamil
Definition
block L Ca channels in HEART MUSCLE slowing phase 4/0 at AV

decreases CO, increases PR, negative inotropic
Term
MOA dialtiazem
Definition
blocks L Ca channel in VESSELS AND HEART causing vasodilation and dec CO
Term
MOA aliodipine
Definition
block L Ca channels in VESSELS causing vasodilation
most likley to cause reflex tachycardia
Term
MOA BB
Definition
antagonize B1 on heart dec CO
antagonize B1 on JG decreasing renin

vasodilation
Na/water excretion
stops cardiac remodeling - some...

improves symptoms, exercise tolerance
Term
administration BB
Definition
low dose, build over 4-5 wks
Term
MOA renin inhibitor
Definition
stops conversion of angiotensinogen to ANG I

vasodilation
Na/water excretion
stoms cardiac remodeling - some...
increased renin due to loss of neg feedback
Term
MOA ALD receptor antagonist
Definition
K sparing diruetics (not awesome diruetics) block ALD which causes K wasting

cause Na/water excretion decreasing preload
Term
MOA a1 adrenergic blockers
Definition
block a1 on ARTERIOLES AND VEINS causing vasodilation
Term
MOA a2 agonists
Definition
decrease sympathetic outflow from brainstem vasopressors (main regulator of Na retention)
Term
MOA peripherial adrenergic blockers
Definition
blocks reuptake of NE/E causig depletion and decreased SNS

vasodilation, dec CO
Term
MOA non-specific adrenergic blockers
Definition
block A1, B1, B2
decrease TPR without reflex tachycardia
Term
MOA hydralazine
Definition
NO causes ARTERIOLE dilation (increases flow most)
Term
MOA minoxidil
Definition
opens K channels hypopolarizing, dilates ARTERIOLES
Term
MOA Na nitropursside
Definition
NO dilates VEINS AND ARTERIES
Term
administration Na nitroprusside
Definition
IV in ICU
Term
MOA isorbide dinitrate
Definition
VENOdilator, decreases proload
Term
TX acute CHF
Definition
B adrenergic antagonist: dobutamine, dopanine
pisphodiesterase inhibitor: inamirone, milrone
Term
TX CHF with AFib
Definition
digitalis
Term
MOA dobutamine
Definition
antagonize B1 and increase CO
Term
administration dobutamine
Definition
IV in ICU
Term
administration of dopamine and effect
Definition
<2ug/kg: D1 vasodilate renal
2-5ug/kg: V1 inc CO
5015ug/kg: A1 vasoconstrict, inc TPR
Term
MOA phosphodiesterase inhibitor
Definition
increase cAMP, phosphorlyates Ca channel
increases CO
Term
MOA
neisritide
Definition
vasodilate veins and arteries
Term
MOA digtaliz and digitoxin
Definition
reversibly bind Na/K ATPase
chances Ca/Na channel
Ca comes in
increases CO
decreases SNS, TPR
Term
what is the difference between digitalis and digitoxin
Definition
digitoxin: t1/2: 15d
digitalis: t1/2: 48h

toxin is more toxic
Term
SE thiazide diruetics 2
Definition
K depletion (restrict Na intake)
increased glucose (don't DC if become diabetic)
Term
interactions thiazide diruetics, why
Definition
digitallis: messes with Na/K ATPase
Term
contraindications thiazide diruetics 3, why
Definition
DM: increases glucose
chronic arrhythmia, acute MI: messes with K
Term
SE ACEI
Definition
catopril cough: due to brady build up
angioedema: face and mouth
teratogenic
acute renal failure
Term
why does ACEI cause acute renal failure
Definition
ANG II constricts efferent arteriole when renal perfusion is low (never use in bilateral renal artery stenosis)
Term
interactions/contraindications ACEI 2
Definition
never use with ARB
dont use in renal artery tenosis
Term
SE ARB 2
Definition
teratogenic
acute renal failure
Term
SE verapamil 3
Definition
constipation
dizzy
naturitic
Term
interactions/contrindications of verpamil 3
Definition
no diruetic: its a naturitic
no CHF
no BB
Term
interactions/contrindications of dialtiazem 3
Definition
no diruetic: its a naturitic
no CHF
no BB
Term
SE dialtiazem
Definition
dizzy
Term
SE amlodipine 3
Definition
gingival hyperplasia
dizzy
reflex tachycardia
Term
contraindications amlodipine
Definition
naturitic: no diruetics
Term
SE BB
Definition
inc LDL and TG
withdrawl: rebount HTN
hypotension
bradycardia
decreased lobido, lethargy

B2: bronchoconstriction, increases glucose
Term
contraindications to BB 2
Definition
dont use non-selective in asthmatic or diabetic
Term
SE aliskirenin 3
Definition
slight cough
angioedema
teratopenic
Term
SE ALD receptor antagonist
Definition
hyperkalemia
Term
contraindications to ALD receptor antagonist 2
Definition
CaCl >30
K > 5
Term
how can you prevent hyperkalemia in ALD receptor antagonist
Definition
use in combo with ACRI/ARB
Term
SE a1 adrenergic blocker 2
Definition
postural HTN on 1st dose
dizzy
Term
SE a2 agonist 4
Definition
sedation
dry mouth
withdrawl: rebound HTN
hemolytic anemia - methyldopa
Term
SE risperpine 3
Definition
sedation
bradycardia
depression
Term
SE non-specific BB 3
Definition
bronchoconstriction
arrhythmia (C blockade)
dec lobido
Term
SE all vasodilators 2
Definition
lupus like in slow acetylators
reflex tachycardia
Term
SE Na nitroprusside, why 2
Definition
hypotension
metabolized to cyanide
Term
tx cyanide poisoning
Definition
thiosulfate
Term
SE digitalis 7
Definition
anorexia, nausea, vomiting, headache, fatigue, confusion, blurred yellow vision
Term
digitalis toxicity signs 8, why
Definition
Ca overload increases automaticity causing DAD leading to ...
increased systole
tachycardia
PVC
fibrillation
complete block
VTac
VFib
Term
things that cause predisposition to digitalis toxicity 4
Definition
hypoklemia: arrhythmia
wuinidine and verapamil: displace it
diuretics: increase its binding
Supporting users have an ad free experience!