Cardiovascular Disease & Pharmacology
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- What class of drugs are used with symptomatic patients with PVC's?
- Class II
- What is the treatment of choice for sustained v-tach?
- Cardioversion or chest thump, Lidocaine for acute treament
- What is the treatment of choice for v-fib?
- Defibrillation
- What do you use in case of digitalis induced V-Tach
- Digibind. Avoid cardioversion except for V-fib.
- What is the treatment for torsades de pointes?
- IV Magnesium bolus (1-2 grams over 5 minutes) also potassium if hypokalemic.
- Name some adverse effects of Class I drugs.
- Negative inotropic effect, Atrial Flutter ( IA = torsades de pointes, digitalis toxicity and hypotension, IC = CAST proarrhythmia - monomorphic sustained V-Tach)
- What is the major cause of Quinidine discontinuation?
- GI disturbances followed by Cinchonism and hypotension
- What are the adverse effects of Class II drugs?
- Sinus Bradycardia, AV Block, Depressed LV function
- Give examples and action of Class IV drugs.
- Verapamil and Diltiazem - Prolong PR interval, Reduce SA node automaticity, Decrease contractility
- When is adenosine used and what is a side effect and what is it's half life?
- Used for supraventricular tachycardias, has 10 sec. half life and metallic taste
- What conditions respond well to RF catheter ablation?
- WPW, AV nodal reentry, Atrial ectopic tachycardia
- What is treatment of choice for A fib/flutter?
- Defibrillation and/or Verapamil, (Digoxin as alternative)
- Which subclass of Class I drugs show a high mortality rate?
- Class IA
- In addition to adenosine, what other drugs may be used for SVTs?
- Class II or digoxin
- What drugs are used for asymptomatic patients with PVCs?
- No drug therapy
- Give examples and action of Class IB drugs.
- Lidocaine and Toacainide. Decrease QT interval
- What is a common side effect of Lidocaine?
- Tinnitus
- What is a side effect of procainamide?
- Hypotension, Lupus and arthritis
- Give examples and actions of Class IC drugs.
- Flecainide and Ecainide. Prolong QRS interval
- What are some side effects of flecainide?
- Dizziness and Tremors
- Give examples and actions of Class II drugs?
- Propanolol. Slow sinus rhythm, prolong PR interval, no effect on QRS
- Give examples and actions of Class III drugs?
- Amiodarone (Codarone, Pacerone) and Bretylium (Prolong repolarization)
- What are some side effects of Amiodarone?
- Pulmonary toxicity and fibrosis, damage to eyes, liver, thyroid, and death
- Why is heparin use ok during pregnancy and how is it administered?
- Unable to cross placenta or enter breast milk. IV
- In what conditions is heparin used?
- PE, evolving stroke, DVT
- What do you monitor for signs of bleeding with heparin use?
- BP, Increased HR, bruises, petechiae, red or black stools, discolored urine, lumbar pain
- How does the parasympathetic system effect the heart?
- Slows impulses from SA node, slows AV node conduction, constricts coronary arteries, reduces contractility
- How does the SNS effect the heart?
- From T1-T5, speeds SA and AV nodal conduction, dilates coronary arteries
- Give examples and action of Class IA drugs.
- Quinidine, Procainamide, Disopyramide. Prolong QRS interval and prolong QT interval
- Describe how Morphine works in ischemia?
- Controls pain, venodilation and some arterial dilation reduce preload and afterload lower cardiac oxygen demand
- What does aspirin inhibit to prevent thrombus formation?
- Cyclo-oxygenase
- Which anti-platelet drugs have less intracranial hemorrhage & GI bleeding than aspirin?
- Adenosine diphosphate receptor antagonists (Clopidogrel and Ticlopidine)
- Which adenosine disphosphate receptor antagonist is approved for prevention of ischemic stroke?
- Ticlopidine
- How are glyco-protein IIB/IIIA receptor antagonists used therapeutically?
- Short term prevention of ischemic events in patients with acute coronary syndrome and patients undergoing PCI
- What is the mechanism of fractionated heparin?
- Binds to antithrombin to enhance ability to inactivate thrombin and factor Xa. Suppresses fibrin formation
- How would you treat stable angina?
- Aspirin, BB, ACEI, Lipid lowering drug if LDL >130, sublingual nitroglycerin. CCB's where BB contraindicated
- How do you recognize variant angina on an EKG?
- ST-sement elevation that has sharper less rounded transition into T-wave. Returns quickly to baseline with nitroglycerin
- How do you treat variant angina?
- CCB's and Nitro (both relax coronary artery spasm)
- What sequence of steps would you take in treating unstable angina?
- Aspirin, Oxygen, Nitro, get and EKG
- When is Nitro contraindicated?
- Rt heart MI, Aortic stenosis, Hypertrophic cardiomyopathy
- What is a normal dose of chewable aspirin initially used in unstable angina?
- 325mg
- What is a common substitute for aspirin sensitivity?
- Clopidogrel
- What meds are used at discharge to control ischemia?
- Sublingual nitro, aspirin or clopidogrel, Lipid lowering drugs if LDL >130
- What problem may exist with using Thiazide in diabetes?
- Promotes hyperglycemia
- What type of drug should not be used together with ACEI?
- Angiotensin II receptor blocker
- What drug type is commonly used in heart failure?
- Diuretics
- What drug type should be avoided in asthmatics?
- BB
- What drug is used in a hypertensive emergency?
- Sodium Nitroprusside (IV)
- Why don't you use a BB with variant angina?
- Doesn't do anything for vessel spasm
- Which CCB does not work on the heart?
- Nifedipine
- What EKG signs exist for stable angina?
- ST-segment depression or T-wave inversion. ST-segment returns to baseline after attack
- What values indicate pre-hypertension?
- 120-139 or 80-89
- What BP is considered normal?
- <120 and <80
- What values indicate stage 1 hypertension?
- 140-159 or 90-99
- What values indicate stage 2 hypertension?
- >160 or >100
- At what classification of HTN are 2 drugs recommended?
- Stage 2
- What type of HTN drug is recommended with renal disease?
- ACEI
- What type of HTN drug increases MI risk in diabetics?
- CCB's
- What negative effect do BB have in diabetics?
- Blunt hypoglycemia symptoms
- What is the drug of choice for acute angina attacks?
- Nitroglycerin
- Nitroglycerin is highly water soluble. True or False?
- FALSE
- What are some adverse effects of Nitro?
- Headaches, Orthostatic hypotension, Reflex tachycardia
- How can you prevent reflex tachycardia of Nitro?
- Pretreat with BB or verapamil
- Why should Nitro be avoided with Sildenafil (Viagra)?
- Intensifies vasodilation
- What dosage levels are normally used for Nitro when taken sublingual?
- .3-.6mg
- Why are sublingual tablets more effective at lower doses than oral Nitro?
- Don't go thru first pass metabolism
- Name some side effects of Nifedipine.
- Reflex tachycardia, flushing, increased mortality in patients with MI and unstable angina
- What effect do Verapail & Diltiazem have on the heart?
- Suppression
- Name 2 ACEIs.
- Captopril and Enalapril
- How do ACEIs work?
- Prevent formation of angiotensin II and stops angiotensin II mediated vasconstriction and aldosterone mediated volume expansion
- What side effects exist with ACEI?
- Persistent cough, Hyperkalemia, Fetal damage, First dose hypotension
- Name 2 aldosterone receptor blockers.
- Eplerenone and Spirolactone
- How do aldosterone receptor blockers work?
- Promotes renal excretion of water and sodium
- What is one adverse effect of aldosterone receptor blockers?
- Hyperkalemia
- Name 2 direct acting vasodilators.
- Hydralazine and Minoxidil
- How do direct acting vasodilators work?
- Dilation of arterioles
- Name some adverse effects of direct acting vasodilators.
- Reflex tachycardia, renin release, fluid retention (adverse effects decreased when diuretic used in combination)
- Name 2 groups of CCB.
- Dihydropyridine (Nifedipine) and Nondihydropyridines (Verapamil and Diltiazem)
- How do CCB work?
- Dilation of arterioles, decreases oxygen demand
- Name some adverse effects of BB and when are they contraindicated.
- Bradycardia, decreased AV conduction, depression, bizarre dreams. Don't use with sick sinus syndrome, 2nd or 3rd heart block, Asthmatics and caution with diabetics
- Name 1 or 2 alpha1 blockers.
- Doxazosin and Terazosin
- What is the mechanism of alpha1 blockers and what is a big side effect?
- Block vasoconstriction. Cause sever orthostatic hypotension with initial dose. NOT recommended as first line therapy
- Name 2 alpha/beta blockers.
- Carvedilol and Labetalol
- Name 2 centrally acting alpha2 agonists.
- Clonidine and Methyldopa
- How do centrally acting alpha2 agonists work?
- Acts within brainstem to suppress sympathetic outflow to heart and blood vessels
- Name 2 adverse actions of centrally acting alpha2 agonists.
- Rebound hypertension with clonidine if therapy abruptly stopped. Methyldopa can cause hemolytic anemia
- What type of diuretic is considered 1st line therapy in HTN?
- Hydrochlorothiazide
- What are some negative effects of Hydrochlorothiazide?
- Hypokalemia, Hyperglycemia, Hyperuricemia
- Name a common loop diuretic and a common side effect.
- Furosemide, Same side effects as Thiazides plus hearing loss
- Name a K+ sparing diuretic.
- Sprionolactone
- How does a BB work in treating HTN.
- Decreases HR and Renin release
- How does a BB with intrinsic sympathomimatic activity differ from a regular BB?
- Produce mild stimulation of beta receptors while blocking receptor stimulation of strong agonists
- Name some common BBs.
- Propranolol and metoprolol
- Nam some common BBs with ISA.
- Carteolol, Acebutolol, Pentutolol, Pindolol
- What are the minor criteria for ARF?
- Fever, Leukocytosis, Arthralgias, Previous Rheumatic fever, Pronlong PR Interval, and Elevated acute phase reactants
- What is evidence of prior group A Beta-hemolytic strept?
- Positive throat culture, elevated strep antibody test - anti-streptolysin O, Anti-DNAse, Streptozyme
- How do you treat ARF?
- Single dose IM benzathine penicillin and aspirin for arthritis and carditis
- How do you treat chorea?
- Haloperidol
- How do you treat ARF long term?
- IM benzathine benzylpenicillin 1.2 million units every 28 days
- Name some causes of secondary hypertension.
- Chronic renal failure, oral contraceptives, coarctation of aorta, primary aldosteronism, pheochromocytoma
- List some lifestyle modifications to control HTN?
- Wt. loss, sodium restriction, DASH, alcohol restriction, aerobic exercise, smoking cessation, maintain K+ and Ca++
- What are the criteria of diagnosis for Kawasaki?
- Fever (5 days or more), Red palms and soles of feet, rash, bilateral conjunctival congestion, changes of lips and oral cavity, unilateral nonpurulent cervical lymphadenopathy
- Within how many days is treatment needed for Kawasaki?
- 10 days
- What is the treatment for Kawasaki?
- Intravenous gamma globulin (IVGG), high dose aspirin (80-100mg/kg/day in 4 divided doses up to 14 days
- What is the pathophysiology for ARF?
- Antigenic similarities between cellular components of strep and the host tissue. Connective tissues effected
- What areas are affected by ARF?
- Connective tissues - heart, brain, joints, cutaneous and subcutaneous tissues
- What normally precedes ARF 2-6 weeks?
- Pharyngitis
- According to Jones, criteria diagnosis of ARF requires what?
- Evidence of prior strep infection and one major and two minor or two major manifestations
- What are the major criteria for ARF?
- Polyarthritis, Erythema maginatum (pink macules on trunk), Carditis, Chorea, Subcutaneous nodules (nontender nodes on ankles, knees, elbows, scalp
- Describe the pathophysiology of SBE.
- Blood borne pathogen adheres to damaged endocardium, proliferation of microorganisms, vegetations develop on heart valves
- Who are at high risk for SBE and moderate risk?
- Prosthetic cardiac valves and complex cyanotic congenital heart disease. Moderate - mitral valve prolapse with regurg.and/or thickened leaflets
- When is SBE prophylaxis NOT recommended?
- Surgical repair without residual beyond 6 months in septal defects, patent ductus arteriosus, mitral valve prolapse without regurg.
- When is SBE prophylaxis recommended?
- Dental procedures known to cause bleeding, urethral catheterization in urinary tract infections, tonsillectomy/adenoidectomy
- What meds are used for SBE prophylaxis?
- Amoxicillin:2gm 1 hour prior. Or Ampicillin, Clindamycin, Cephalexin or Azithromycin or Clarithromycin
- What other name is Kawasaki Disease known as?
- Mucocutaneous lymph node syndrome
- What causes, who is affected, and what time of the year is associated with Kawasaki?
- Suspect viral. Spring time. Asian children most susceptible
- What is the pathophysiology of Kawasaki?
- Cell mediated immune response attack on medium sized vessels leading to aneurysms and increased clots
- What drug is used to prevent the reoccurence of V-Fib
- Lidocaine
- What are some alternative therapies for V-Fib
- Amiodarone, Procainamide or Bretylium to prevent recurrence, RF Ablation or ICD
- What electrolyte may serve as an alternative treatment in digitalis induced V-Tach
- Potassium if hypokalemic
- What are the adverse effects of Class III drugs?
- Sinus Bradycardia and Torsades de Pointes
- What are the adverse effects of Class IV drugs
- Sinus Bradycardia, AV Block, and Heart Failure
- Give some characteristics of torsades de pointes
- Can rapidly develop into V-Fib, often seen with hypokalemia and hypomagnesmia and drug induced long QT syndrome (DILQTS)
- Which antiarrhythmic drug has the lowest toxicity incidence
- Lidocaine
- What may you risk with the sudden withdrawal of a BB in a patient with angina
- Precipitate angina, MI, Cardiac Arrhythmia
- What are some side effects of Verapamil
- Hypotension, Increases serum concentration of digoxin
- What type of side effects does Digitalis have
- Headaches, GI Distress, Confusion, Anorexia
- What is a common side effect of Adenosine
- Hypotension
- How does a BB work as an antiarrhythmic
- Decreases SA nodal automaticity, Decreases AV nodal conduction velocity, Negative inotropic effect
- What is the drug of choice for PSVT
- Adenosine IV bolus
- How would you treat someone with triglycerides greater than 500mg/dL
- Use fibrate or nicotinic acid
- How would you manage CHD patients or CHD - at risk patients who have low HDL levels
- Utilize nicotinic acid or fibrates
- What type of drugs decrease HR and Contractile force
- BB and CCB
- What type of drugs decrease blood volume
- Diuretics
- What type of drugs decrease venous return
- Vasodilators
- Name a side effect of Spironolactone
- Hyperkalemia (Do not use with other drugs that promote hyperkalemia like ACEI and angiotensin II receptor blockers)
- What are the side effects of Nifedipine
- Reflex tachycardia and increase mortality in patients with MI and unstable angina
- Name three Angiotensin II Receptor Blockers
- Candesartan, Losartan, and Valsartan
- When are angiotensin II receptor blockers contraindicated
- During pregnancy
- How does nitro work in stable angina
- Decreases venous return (decrease preload), decreases cardiac oxygen demand
- How does nitro work in variant angina
- Relaxes or prevents coronary artery spasm, Increase oxygen supply
- What is the mechanism of nitro tolerance development
- Depletion of sulfhydryl groups in vascular smooth muscle
- True or False. Long acting nitro should be discontinued slowly to avoid vasospasm
- TRUE
- Why is aspirin used
- Reduce risk of coronary thrombosis (primary and secondary MI prevention)
- What are the major side effects with aspirin
- GI bleeding and Hemorrhagic stroke
- What is the prevention dosage of aspirin
- 81-160mg/day
- What group of antiplatelet drugs are referred to as super aspirins
- Glycoprotein IIB/IIIa receptor antagonists
- When should Furosemide be used
- In patients needing more diuresis and who have low GFR
- What enzymes rapidly inactivate Nitro
- Hepatic
- Name 3 mechanisms of action BB play in ischemic heart disease treatment
- Decrease oxygen demand, Increase oxygen supply, Blunts reflex tachycardia
- Why should Verapamil and Diltiazem be cautioned in patients taking BB
- Because they suppress the heart and contractility adding to the effect of the BB
- What are the incations for the use of Clopidogrel (Plavix)
- Secondary prevention of MI, ischemic stroke and other vascular events.
- What is the approved indication for Ticlopidine (Ticlid) use
- Prevention of ischemic stroke and thrombus formation in coronary artery stents
- What are the most effective antiplatelet drugs available
- Glycoprotein IIB/IIIa receptor antagonists (Abciximab, Tirofiban, Eptibatide)
- When is the use of Dipyrimadole (Persantine) indicated
- Prevention of recurrent stroke
- In addition to protamine sulfate what other drug can treat heparin induced thrombocytopenia
- Lepirudin (Refludan)
- What drug would you never send a heart failure patient home on
- Dopamine (Intropin). It is administered by continuous infusion and requires constant monitoring of BP, ECG and urine output
- What is the reason for giving potassium with digoxin
- Potassium ions compete with digoxin for binding to sodium so potassium levels may run low due to excretion
- How does Hydralazine (Apresoline) in combination with isosorbide dinitrate work in heart failure
- It causes selective dilation of veins to reduce preload
- Name some symptoms of heart failure
- Dyspnea, fatigue, peripheral edema, JVD
- List some agents that cause cardiotoxicity
- Alcohol, Chemotherapy
- What is the treatment for lyme carditis
- doxycycline and prednisone
- What drugs are used to treat hypertrophic cardiomyopathy
- BB, Verapamil, Diuretics if evidence of heart failure
- What syndrome is associated with pericardial disease after a MI
- Dressler's Syndrome
- How do you treat pericarditis
- Nonsteroidal anti-inflammatory drugs (Indomethacin, Aspirin, Prednisone)
- Describe a holosystolic murmur
- Begins abruptly with S1 and continues at same intensity to S2
- Name two conditions that cause holosystolic murmurs
- AV valve regurgitation and ventricular septal defects
- Describe the sound of an ejection murmur
- Crescendo-Decrescendo
- What causes an ejection murmur
- Narrowing of the seminlunar valves
- Describe an early systolic murmur
- Starts abruptly with S1 but tapers and disappears before S2
- What causes an an early systolic murmur
- A small muscular ventricular septal defect
- What conditions are associated with mid to late systolic murmurs
- Midsystolic clicks, mitral valve prolapse and/or sufficiency
- What causes a diastolic murmur
- Semilunar valve regurgitation, AV valve stenosis, Increased flow across AV valve. These all are pathologic
- Where can pulmonary valve stenosis be heard and what does it sound like
- Loud click or sharp sound at upper left sternal border that is louder with expiration
- What is the most common innocent murmur in children
- Vibratory Still's Murmur
- At what ages is a Vibratory Still's murmur typically audible
- 2 to 6 years of age
- Name some characteristics of a Vibratory Still's murmur
- It is confined to early systole. Loudest in supine position and diminishes but doesn't disappear in a seated position. Musical twanging quality
- What are the characteristics of a pulmonary flow murmur
- Rough sound. Heard best in the supine position and diminished with upright positioning and breath holding
- Where is a venous hum most audible
- Lateral to sternocleidomastoid above clavicle (louder on rt. side and with patient sitting). Lying down may resolve or diminish.
- What does a machinery murmur represent
- Patent ductus arteriosus. Murmur is continuous at upper left sternal border
- What causes a Carey Coombs murmur
- Increased diastolic blood flow across the mitral valve in presence of mitral insufficiency. Heard at apex.
- What causes a third heart sound (gallop)
- Filling of the left ventricle in heart failure
- Describe an Austin Flint murmur
- Low frequency diastolic murmur with presystolic accentuation. Heard at apex in presence of aortic valve insufficiency
- Describe the atherosclerotic process
- How often should a fasting lipid profile be obtained in adults over 20 years
- Once every 5 years
- What is the optimal LDL level and when is it considered high
- Less than 100 optimal; 160-189 high
- What values are considered low and high for HDL
- <40; >60
- What is a desirable total cholesterol level and when is it considered high
- <200 desirable; >240 high
- What triglyceride level is considered normal and what is considered high
- <150 normal; 200-499 High
- Name some causes of secondary dyslipidemia
- Diabetes, Hypothyroidism, Obstructive liver disease, Chronic renal failure, Drugs (progestins, anabolic steroids, corticosteriods)
- What are the general features of Metabolic Syndrome
- Abominal obesity, HTN, Insulin resistance, Elevated triglycerides, low HDL and small LDL, Prothrombotic and Proinflammatory state
- Name 3 causes of Metabolic Syndrome
- Overweight and obesity, Physical Inactivity and High Carb Diet
- List the major risk factors that modify LDL goals
- Cigarette smoking, HTN (>140/90 or on meds), Low HDL (<40mg/dL), Family History of CHD, Age, Diabetes
- List some common side effects of HMG CoA Reductase Inhibitors (Statins)
- Headache, GI distress, Myalgia, Liver Enzymes
- Name one condition that is an absolute contraindication for statin use
- Liver disease
- How do bile acid sequestrants work
- Bind bile acids forming insoluable complex excreted in stool. Cholesterol oxidized to make more bile.
- Name four side effects with bile acid sequestrants
- GI distress/constipation, Malabsorption of fat soluable vitamins (ADEK), decreased absorption of warfarin and statins, increase Triglycerides
- What are some side effects of Nicotinic Acid
- Flushing, Hyperglycemia, Hyperuricemia, Hepatotoxicity
- When is Nicotinic Acid contraindicated
- Liver disease, severe gout, and caution with diabetics
- What are the drug intervention steps for dyslipidemia
- Step 1 (after 3 months of TLC) = statins, bile acid sequestrant or nicotinic acid, follow-up in 6 weeks. Step 2 = higher dose statin or combine statin + bile acid sequestrant or statin + nicotinic acid. Step 3 = Refer to lipid specialist
- What is the most common birth defect
- Congenital heart disease
- What heart conditions are associated with Marfan syndrome
- Aortic or mitral regurgitation
- What heart conditions are associated with Turner's syndrome
- Coarctation
- What heart conditions are associated with Holt-Oram
- Atrial septal defect. The child also is born without a radius
- What heart conditions are associated with Trisomy 18
- VSD and Patent ductus arteriosus
- A patent ductus arteriosus may cause what
- Pulmonary congestion/HTN and Left ventricular failure
- What murmur sound is associated with a patent ductus arteriosus
- Machinery murmur
- What is the treatment for patent ductus arteriosus
- Fluid restriction, Indomethacin (blocks synthesis of prostaglandins which keep ducutus open), Surgery
- How can a patent ductus arteriosus be prevented
- Rubella immunization in women and good pre-natal care to prevent pre-maturity
- What defect is the most common of all congenital heart defects
- Ventricular septal defect
- How can a small ventricular septal defect be recognized
- Loud, harsh pansystolic murmur along left sternal border (3rd and 4th space), accompanied by thrill
- How are small ventricular septal defects treated
- Spontaneous closure in 30% of cases, SBE prophylaxis
- How does a large ventricular septal defect effect the pulmonary system.
- Pulmonary HTN develops eventually leading to reversal of left-to-rt. shunt to rt.-to-lt. shunt = cyanosis
- How can a large ventricular septal defect be recognized on exam.
- Low pitched diastolic murmur at apex from increased blood flow across mitral valve. An ECHO may show thickening of rt. ventricle wall (due to elevated pulmonary arterial pressure) and enlargement of left atrium and ventricle due to volume of pulmonary blood flow
- What is the primary treatment for large ventricular septal defects
- Surgery - suture closure or patch
- What happens to the lower body BP, pulse and color with an aorta coarctation
- BP is lower, pulse absent of weak and have cyanosis. Upper body has elevated BP and bounding pulses.
- What are the 4 classic findings of Tetralogy of Fallot
- Pulmonary stenosis (causes oxygen poor blood to be pumped out aorta = cyanosis), VSD, Overriding aorta, and Right Ventricle Hypertrophy
- What is the most common cardiac malformation causing cyanosis in patients >2yrs. old.
- Tetralogy of Fallot
- How can Tetralogy of Fallot be recognized on a CXR
- Boot shaped cardiac contour, Prominent aorta, Diminished pulmonary vascular markings
- What are some signs/symptoms of Tetralogy of Fallot
- Cyanosis (child squats to rest on exertion), Dyspnea, Clubbing
- How do you treat Tetralogy of Fallot
- Corrective surgery by 18 months, adequate diet and fluids
- What do you give in case of Heparin overdose
- Protamine sulfate (low dose)
- How is Heparin monitored
- Activated partial thromboplastin time (aPTT). The goal is 60-80 seconds
- Name one of the most serious adverse effects of Heparin
- Thrombocytopenia
- What are the advantages of LMWH over Heparin
- No aPTT monitoring, home therapy, less risk of thrombocytopenia and bleeding, fixed dose schedule
- What is the mechanism of action for LMWH
- Inactivates Factor Xa, less able to activate thrombin like unfractionated Heparin
- When would you use LMWH
- Ischemic stroke, DVT (prevention and treatment), PE, Non-Q-wave MI
- What is Warfarin (Coumadin)'s mechanism of action
- Blocks synthesis of Vit. K dependent clotting factors (VII, IX, X and prothrombin)
- How does low albumin affect coumadin
- Low albumin increases the amount of unbound coumadin in blood
- Why shouldn't coumadin be used during pregancy or breast feeding
- It crosses the membranes very easily causing fetal hemorrhage and teratogenesis
- What are Class IA drugs used for
- Atrial fibrillation and Ventricular Arrhythmias
- What are Class IB drugs used for
- Ventricular Arrhythmias
- What are Class IC drugs used for
- AV Nodal Rentry, WPW, Ventricular Arrhythmias (can increase mortality despite suppressing PVC's)
- What are Class II drugs used for
- Atrial Fibrillation/Flutter and Ventricular Arrhythmias
- What are Class III drugs used for
- Atrial Fibrillation/Flutter and Ventricular Arrhythmias
- What are Class IV drugs used for
- Atrial Fibrillation; Atrial Automaticities and AV Nodal Rentry
- What is Adenosine used for
- AV Nodal Rentry and Orthodromic tachycardia
- What is Digitalis used for
- Atrial Fibrillation/Flutter and AV Nodal Rentry
- What is the treatment for Torsades de Pointes
- Magnesium
- Radiofrequency catheter ablation is used to treat what conditions
- Atrial Fibrillation and Monomorphic Ventricular Tachycardia
- What drug alternatives exist for A-Fib/Flutter
- Digoxin, Class IA and IC (long term suppression), and low dose Amiodarone for prevention
- What is the treatment of choice for SVT
- Adenosine
- What is the treatment of choice for sustained ventricular tachycardia
- Lidocaine for acute treatment
- Name some drug to drug interactions with Statins that cause myopathy
- Erythromycin, Fribates, Nicotinic Acids, Verapamil, Amiodarone
- List three major actions of Fibrinic Acids
- Lowers LDL and Triglycerides and Increases HDL
- What lipid lowering drug may eleveate INR's when taken with warfarin
- Fibrinic Acids
- Is warfarin (coumadin) a fast acting anticoagulant
- No. Initial response 8-12 hours after initial dose
- How is warfarin levels monitored
- Monitor prothrombin time (PT). Or International Normalized Ratio (INR)
- What drug has more drug interactions than any other drug
- Warfarin (Coumadin)
- What drugs increase the anticoagulant effect of Warfarin
- Aspirin, Chloral hydrate, Sulfonamides