EVMS Pharm Quiz 4
Terms
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digitalis glycosides:
give class & drugs -
POSITIVE INOTROPIC AGENTS
Digitoxin
digoxin -
adrenergic receptor agonists:
give class & drugs -
POSITIVE IONOTROPIC AGENTS
dobutamine
dopamine -
phosphodiesterase inhibitors:
class & drugs -
POSITIVE IONOTROPIC AGENTS
amrinone jk milrinone - positive ionotropic agents common MOA
- increase cardiac contractility & stroke volume
- digitalis glycosides effects
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increase cardiac contractility
reduce preload
may increase afterload
+ risk of arrhythmia
increases PS tone
decreases sympathetic tone
**** note NO effect on HR - adrenergic receptor agonists effects
-
significant increase in cardiac contractility
may increase HR
may reduce preload
may reduce afterload
may have risk of arrhythmia - phosphodiesterase inhibitors effects
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may increase cardiac contractility
may increase HR
reduces preload & afterload
risk of arrhythmia - list thiazide diuretics
- HCTZ, Indapamide, Metolazone
- list loop diuretics
- Bumetanide, Ethacrynic acid, Furosemide, Torsemide
- list K-sparing diuretics
- Amiloride, Spironolactone, Triamterene
- list osmotic diuretics
- glycerol, mannitol
- list carbonic anhydrase inhibitors
- acetazolamide, dorzolamide
- Side effects of Quinidine
- TdP; TCP; diarrhea; conchism
- side effects of Procainamide
- SLE like reaction (reversible)
- side effects of Lidocaine
- decreased conduction, neurological defects (tremor, paresthesia)
- side effects of tocainide
- agranulocytosis
- side effects of fecainide & Propafenone
- increased risk of death when given to MI patient, ventricular arrhythmias, hem. Toxicities
- side effects of Ibutilide
- TdP
- side effects of Amiodarone
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hypotensiton, skin pigment changes (blue/green), corneal deposits, GI disturbances; be sure to check LFT, PFT, & TFT (liver, pulmonary, & thyroid fxn tests)
***note increased QT segment without TdP - Side effects of Bretylium
- transient HTN followed by prolonged hypotension
- side effects of Sotalol
- Bronchospasm, TdP
- Lidocaine metabolism
- hepatic
- Esmolol metabolism
- esterase (very rapidā¬¦must admin via IV)
- Esmolol uses & admin
- Supraventricular tachycardia during or after surgery; admin IV
- Quinidine uses
- SV/V arrhythmias
- Procainamide admin & uses
-
SV arrhythmia=PO
V arrhythmia=IV/PO - Disopyramide admin & uses
- PO=V arrhythmias
- Lidocaine admin & Uses
- IV=V arrhythmia (including V tachy)
- Mexiletine admin & uses
- PO=V arrhythmias
- Tocainide admin & uses
- PO=V arrhythmias
- Flecainide admin & uses
- PO=SV arrhythmias & life threatening V arrhythmias
- Metaprolol uses
- SV/V arrhythmias; esp for MI patients (admin IV at first then maintenance via PO)
- Propranolol uses
- SV/V arrhythmias
- Ibutilide admin & uses
- IV=SV fib/flutter
- Amiodarone admin & uses
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PO=SV fib/flutter/tachy & life threateninng V tachy
IV=life threatening V fib & sustained V tachy - Amiodarone MOA
- K-channel blocker (increases AP duration); also blocks Na & Ca channels & inhibits Beta receptors
- Bretylium admin & uses
- IV=V fib
- Sotalol uses
- SV arrhythmia (including fib) & V arrhythmias
- meds for SV arrhythmias
- Quinidine, procainamide, Flecainide, class 2 drugs (Esmolol, Metaprolol, Propranolol), Class 3 (except Bret. ) (Ibutilide, Amiodarone, Sotalol)
- meds for SV tachycardia
- Esmolol, Amiodarone
- meds for SV fibrillation
- Ibutilide, Amiodarone, Sotalol
- meds for SV flutter
- Ibutilide, Amiodarone
- meds for V arrhythmias
- class IA (Quinidine, Procainamide, Disopyramide), Class IB (Lidocaine, Mexiletine, Tocainide), Flecainide, Metaprolol, Propranolol, Class 3 (except Ibut.)(Amiodarone, Bretylium, Sotalol)
- meds for Ventricular tachycardia
- Lidocaine, Amiodarone
- meds for V fib
- Bretylium, Amiodarone
- meds for life-threatening V arrhythmias
- Flecainide, Amiodarone
- class IA antiarrhythmics: MOA & list
- Na channel blockers (high affinity for open state; slow recovery): Quinidine, Procainamide, Disopyramide
- class IB antiarrhythmics: MOA & list
- Na channel blockers (high affinity for inactivated, ischemic tissue; rapid recovery): Lidocaine, Mexiletine, Tocainide
- class IC antiarrhythmics: MOA & list
- Na channel blockers (open state, slowest recovery (most effect on ventricular conduction): Flecainide, Propafenone
- class II antiarrhythmics: MOA & list
- Beta-blockers: Esmolol (B1), Metoprolol (B1), Propranolol (B1/2)
- class III antiarrhythmics: MOA & list
- K-channel blocker: Amiodarone, Bretylium, Ibutilide, Sotalol
- class IV antiarrhythmics: MOA & List
- Ca channel blockrs: Verapamil, Diltiazem
- Manitol MOA
- proximal tubule: easily filtered poorly reabsorbed; increases urine osmolarity resulting in increased UO
- glycerine uses
- ophthalmic procedures (admin PO); osmotic diuretic for corneal edema (topical)
- Acetazolamide MOA
- Proximal tubule: inhibits carbonic anhydrase resulting in increased Urinary sodium bicarb; effective in 30 min; decr Cl excretion
- Furosemide MOA
- Thick ascending loop: inhibits Na/K/Cl symporter resulting in decreased urine osmolarity, increased urine Ca "loops lose Ca"; may also act as a carbonic anhydrase inhibitor
- Ethacrymic acid MOA
- Thick ascending loop: inhibits Na/K/Cl symporter resulting in decreased urine osmolarity, increased urine Ca "loops lose Ca"
- HCTZ MOA
- absorbed in early proximal tube (competes for same receptor as uric acid); acts in Distal tubule: inhibits NaCl reabsorption resulting in increased urinie osmolarity, decreased urinary Ca
- K-sparing diuretics "K-STAys" MOA
-
Cortical collecting tubule
Spirolactone competitively inhibits Aldo in tubular cells=reduces Na reabsorption
Triumterene inhibits Na channel in principle tubular cells
Amiloride inhibits Na channel in principle tubular cells - Manitol uses
- glaucoma, cerebral edema, shock, drug OD; may help oliguria if secondary to decr GFR; prophylaxis for acute renal failure by maintaining steady, dilute urine flow
- Manitol side effects
- Pulmonary edema, dehydration
- mannitol contraindications
- anuria, CHF (b/c water is pulled out of cells & into BVs, worsening CHF)
- carbonic anhydrase uses
- rarely used as a diuretic; used for altitude sickness, epilepsy, metabolic alkalosis, acidic urine, glaucoma, gout, hypercystine
- carbonic anhydrase side effects & contraindications
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hyperCl acidosis, sulfa allergy, increased blood sugar & ammonia, hypokalemia, neuro (drowsy & paresthesias), kidney stones (alkaline urine decr solubility of Ca salts), may have exfoliative dermatitis or rash,
*****do not use with hepatic cirrhosis; hypoK - loop diuretics uses & contraindications
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edema (treat CHF by limiting acute pulmonary edema), HTN, hypercalcemia & halide poisoning; DOC for edema secondary to CHF or cirrhosis
****can be used in renal impaired patients - loop diuretics side effects
- "OH DANG" ototox (esp. ethacrymic acid), hypo(K, Ca, Mg, H, TN)/hyper(glycemia, uremia), dehydration, allergy to sulfa (except ethacrymic acid), nephritis (interstitual), gout
- loop diuretic drug interactions
- 1) increase ototox, 2) reduce lithium clearance, 3) reduce salicylate excretion, 4) inhibits NM blocking effect of tubocurarine
- thiazides uses & contraindications
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HTN, edema (assoc. w/ CHF, cirrhosis, estrogen therapy, nephrotic syndrome), Diabetes Insipidus by increasing ADH, hypercalciuria (along with Ca related kidney stones)
***use cautiously w/ renal/hepatic diseases, diabetics - thiazides side effects
- "hyperGLUC"=hyper (glyc., lipids, uremia, Ca), hypoK, Na, Cl=metabolic alkalosis (leading to dizziness, confusion, irritability, weakness, arrhythmias) and decreased insulin, sulfa allergy, athrogenesis, pancreatitis
- K-sparing diuretics uses
- normally in combo w/ thiazide or loop diuretic; hyperaldosterone (adrenal hyperplasia & aldo producing adenoma), K-depletion, CHF; Amiloride & triamterene used for CHF, cirrhosis, & edema secondary to hyperaldo); Ami + HCTZ=for HTN;
- K-sparing diuretics side effects & contraindications
- glaucoma, cerebral edema, shock, drug OD; may help oliguria if secondary to decr GFR; prophylaxis for acute renal failure by maintaining steady, dilute urine flow
- K-sparing diuretics ADME
- PO=Spironolactone: absorbed by GI then metabolized by liver to diuretic Canrenone; several days to see effects; Triamterene & Amiloride: secreted into PT & effective after 2-4 hrs. (Triamterene is metabolized in the liver)
- drug combo to treat diuretic resistant patient
- Metolazone & loop diuretic
- Which diuretics are "high ceiling diuretics" & what does this mean?
- Loop diuretics=dose dependent response throughout dosage range
- What side effect makes one vulnerable to digitalis-induced cardiac arrhythmias
- hypoK
- Which diuretics have a side effect of hyperglycemia
- Loop & Thiazides
- digitalis glycosides
- digitoxin, digoxin
- adrenergic receptor agonists
- dobutamine, dopamine
- phosphodiesterase inhibitors
- amrinone, milrinone
- digitalis glycosides MOA
- inhibits Na/K/ATPase-->decreased fxn of Na/Ca antiport-->incr intracellular Ca
- digitalis glycosides side effects
- anorexia, nausea, vomiting, arrhythmias (incr afterdepolarization--> extrasystoles & tachy; AV block), neuro (blurred vision & chromatopsia (objects appear unnaturally colored), estrogenic activity (gynecomastia), antidote=digoxin immune Fab
- digoxin ADME
- T1/2=35 hrs; renal excretoin
- digitoxin ADME
- T1/2=1 wk with extensive metabolism
- digitalis EKG effects
- decreases QT interval, increases PR interval, ST segment depression; T-wave inversion
- digitalis uses
- heart failure (does not prolong survival but does reduce symptoms); atrial fib (drug slows ventricular rate)
- adrenergic receptor agonists admin & uses
- IV=short term management of acute heart failure & cardiogenic shock
- adrenergic receptor agonists effect
- stimulate cardiac contractility-->less tachy than other B-adrenergic agonists; Dobutamine=mild VD; Dopamine=renal & splanchnic VD
- phosphodiesterase inhibitors uses
- short term management of acute heart failure or acute exacerbations of chronic heart failure
- phosphodiesterase inhibitors side effects
- thrombocytopenia & ventricular arrhythmias
- phosphodiesterase inhibitors MOA
- inhibits type 3 phosphodiesterase & increases cAMP-->incr cardiac contractility & VD
- adenosine use
- DOC for diagnosing/abolishing AV nodal arrhythmia
- potassium uses
- depresses ectopic pacemakers, especially in digoxin toxicity
- Magnesium uses
- effective in TdP & digoxin toxicity
- Ca channel blockers: Verapamil & Diltiazem MOA
- primarily affects AV nodal cells; decreases conduction velocity, increases ERP, increases PR interval
- Ca channel blockers: Verapamil & Diltiazem uses
- prevention of nodal arrhythmias (SVT)
- Ca channel blockers: Verapamil & Diltiazem side effects
- constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression)
- list antiarrhythmics that decrease HR
- class 2, class 3 (exc Bret.), class 4, digoxin *note class1A +/-
- list antiarrhythmics that increase PR interval
- class IC, class 2, class 3 (except Bret.), class 4, digoxin, adenosine *note class 1A +/-
- list antiarrhythmics that increase QRS duration
- class 1A & C, Amiodarone
- list antiarrhythmics that increase QT interval
- class 1A & C, class 3 (exc.Bret.), *****Amiodarone is greatest prolongation
- list antiarrhythmics that decrease QT interval
- class 1B, digoxin
- list antiarrhythmics that increase HR
- adenosine
- list antiarrhythmics with increased ectopic automaticity
- Bretylium & digoxin
- list antiarrhythmics with no change to AV conduction velocity
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Class IB, Bret., MgSO4
**note all other drugs in this chapter decrease AV conduction velocity & Increased AV refractory period - list antiarrhythmics with decreased His conduction velocity
- Class I, Amiodarone; ***note all others in this chapter have no change (exc Bret may increase His conduction velocity)
- list antiarrhythmics with increased His refractory period
- Class I, class 3 **note IB may decrease
- list antiarrhythmics with decreased His refractory period
- digoxin, (& maybe class IB)
- antiarrhythmics associated with torsade de pointes (TdP)
- Quinidine, Ibutilide, Sotalol