Term
cardiac glycosides inhibit what?
this normally does what? |
|
Definition
Na/K ATPase
pumps Na out of the cell |
|
|
Term
what makes up the Na/K ATPase?
where do cardiac glycosides bind? |
|
Definition
2 b and 2 a subunits
PHOSPHORILATED alpha subunit |
|
|
Term
what promotes dephosphorilation of the Na/K ATPase?
what effect does this have? |
|
Definition
extracell K+
decreases interaction with cadiac glycosides |
|
|
Term
| the functoin of Na/K ATPase(Na efflux) is to intiate what? |
|
Definition
|
|
Term
| cardiac glycosides cause 2 things associated with contractions |
|
Definition
delayed relaxation
increased contractions |
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|
Term
| cardiac glycosides affect vagal tone and sympathetic acitivty how? |
|
Definition
increase tone
decrease sympathetic |
|
|
Term
cardaic glycosides:
_ AV conductance
_ AV refractory period |
|
Definition
|
|
Term
| hows does hypokalemia affect digoxin efficacy? |
|
Definition
| increases, even to toxicity. bc no K to dephosphorilate the ATPase |
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|
Term
Mg vs Ca
which one increases digoxin toxicity with elevated concentration? |
|
Definition
|
|
Term
how big is the therapweutic index of cardiac glycosides?
what serum concentrations are effective? |
|
Definition
|
|
Term
| if pateint has liver or renal problem do you lower digoxin dose |
|
Definition
|
|
Term
| digoxin absoprtion is inhibtied by-2 |
|
Definition
antacids
bile acid sequestrant |
|
|
Term
| what 3 meds do you caution digoxin use in |
|
Definition
diltiazem
verapamil
diuretics |
|
|
Term
| main ADE of cariac glycosides |
|
Definition
|
|
Term
| what are the 2 contrindicaitons for digoxin |
|
Definition
cardiomyopathies
ventricular fibrilation |
|
|
Term
| which drug is used in patients with HF and SYSTOLIC dysfunction |
|
Definition
|
|
Term
| dobutamine stimualtes what receptors? |
|
Definition
|
|
Term
| dobutamine has 3 effects on heart- what are they and what recptor causes them |
|
Definition
increase stroke volume- B1
increase heart rate- B1
decrease PR- B2 |
|
|
Term
what is the most popular cardiac glycoside?
why? |
|
Definition
digoxin
has oral formulation |
|
|
Term
which drug is used more- dobutamine, epinephrine, or NE?
why? |
|
Definition
dobutamine
bc doesnt stimulate the alpha receptors! |
|
|
Term
what are the 3 positive effects that epinephrine has on the heart?
what doesnt it have an effect on? |
|
Definition
ino-force
dromo- AV conductance
chronotrop- rate;
PR |
|
|
Term
| epinipehrine also has metabolic effects on these 2 organs- why? |
|
Definition
lungs, eyes
bc of B2 recptor |
|
|
Term
| what are the cautions for using Epi |
|
Definition
glaucoma
diabetes
hyperthyroid
shock |
|
|
Term
| what drug has its solution as light sensitive |
|
Definition
|
|
Term
|
Definition
hypertension
headache
chest pain |
|
|
Term
| NE has what effect on the heart? |
|
Definition
| vasoconstriciton-> increased PR |
|
|
Term
| what is the precursor of NE and EPi |
|
Definition
|
|
Term
| what are the high, medium, and low doses for dopamine |
|
Definition
high- >5 mcg/kg/min
medium-2-5
low- <2 mcg/kg |
|
|
Term
at low dosed dopamine what recptors are affected and what affect do it have?
what does this do- 3 |
|
Definition
D1 - vasodilation
D2-decreaseNE rlease
renal tubelar- natriuresis |
|
|
Term
| at medium dose dopamine acts on what recptor? what is the effect-2 |
|
Definition
B2
increase Ne
increase contraciton |
|
|
Term
| at high dose of dopamine what recptors are stimulated? what is the effecT? |
|
Definition
|
|
Term
|
Definition
| tachycardia, palpitations, hypotension |
|
|
Term
| what drug is used as short term support for circulation in heart failure? |
|
Definition
|
|
Term
MOA of milrinone
where at? |
|
Definition
inhibition of PDE3 to prevent cAMP from being converted to inactive AMP
myocardium &
vasculature |
|
|
Term
| an increase in cAMP affects what 2 things and how |
|
Definition
decrease PR
increase contractility |
|
|
Term
| how are b1 and b2 agonists similat to PDE inhibitors (how are they synergistic) |
|
Definition
the B agonists are Gs-> make more cAMP
PDE inhibitors prevent it from becoming inactive |
|
|
Term
| how do you adminster milrinone |
|
Definition
|
|
Term
|
Definition
| arrythmia, hypotension, thrombocytopenia |
|
|
Term
| with myocardial injury- what does continued SNS activation (catecholamines) do? |
|
Definition
| causes contraction dysfunction |
|
|
Term
| positive ionotropes are used for what type of HF? |
|
Definition
|
|
Term
what type of HF are beta antagonists used for?
why? |
|
Definition
mild-moderate HF
block harmful effects of SNS stimulation on heart |
|
|
Term
| what is the B1 anatagonist used in HF? |
|
Definition
|
|
Term
| what is the mixed alpha and beta antagonists used for HF? |
|
Definition
|
|
Term
what are the mian recptor targets of the B antaognists
where are the recepotrs located |
|
Definition
|
|
Term
| how do B antagonists effect systolic function |
|
Definition
| decrease in beginning but after 2 months improves. |
|
|
Term
| what are 4 good effects of B antagonists |
|
Definition
+ remodeling
-anti-ischemic
-inhibition of renin release
-anti-arrythmia |
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