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55 Cards in this Set
- Front
- Back
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Antihypertensive w breastfeeding
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A B C2 D P
non ti poul la D: HS C: DeVieNt |
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Antihypertensive drugs combinations
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AC / AD
C ar d Polypill |
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Dara cpds
treat which disease |
block ET1 & AT1 (ARB)
hypertension, Diabetes nephropathy, CHF |
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How should be BP @ night?
talk about the 3 grps Which grp is at risk of CV event? What r the causes of it? What BP best predict CV morbidity? who usually are Non dippers? |
It should drop
dippers/ non dippers/ raisers NON dippers, sleep apnea & resistant hypertension Noctural BP Older, obese, dyslipidemic (Metabolic Syndrome) |
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... is an indication of resistant hypertension.
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Sleep apne
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Antihypertensive drugs at bed time
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A2: li quite rape enervee ,vito
B: PC C: DV NIC D: tor |
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Antihypertensive drugs in the morning
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Diuretics+_ ACEI ben, ARB can, BB-2 mac, CCB-2 anis
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3 drug antihypertensive don't work, failed?
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Resistant Hypertensive
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Define sleep apnea
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+ than 30 periods of respiratory cessation per night
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T or F
Dose of Aspirin >100 mg/d do not interfere w BP lowering of an ARB |
F
Dose of Aspirin less, x<100 mg/d do not interfere w BP lowering of an "ACEI" |
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Drug interactions with hypertensive medications
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C-4 L A N-2
NSAIDS nasal decongestants amphetamines cocaine contraceptives erythropoietin cyclosporin glucocorticoids licorise |
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Top reasons for lack of BP control
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Poor compliance
excessive alcohol intake concomitant conditions: metatbolic syndrome, high salt intake, obesity, type 2 DM, Sleep apnea sympathomimetics, NSAIDs, antidepressants Insufficient dose/ drug using drugs with same mechanism of action other causes of HT: Renal arterystenosis, primary aldosteronism, pheochromocytoma |
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T or F
All drug with type II activity induce severe arrythmia |
F
All drug with type "III" activity induce severe arrythmia (K relaxes heart) |
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Decrease conduction velocity & increase QRS
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type I (Na)
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similarities of type I
cptmim |
Correct K levels
Torsade de pointes Prolong QRS (excess) Monitorin: ECG, WBC, platelets caution if contractility depress by disease or drug Immunological SE MOA & clinical indications |
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SE of quinidine
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Cinchonism
Diarrhea alpha blocking activity |
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strong anticholinergic is seen with type I, which one?
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Disopyramide
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Lupus (drug induced) is seen with type I, which one?
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procainamide, slow acetylators
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... & ... prolong QT
Hypotension due to ganglionic blockade |
NAPA & Procainamide(+++)
NAPA doesn't block Na channels Procainamide |
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Pacemaker cells are affected by...
What happen there? |
Type II (BB)
& type IV (CCB) Depolarization by Ca inward, they depress phase 4 |
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Type II drugs, with type III effect
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Sotalol
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Drugs with all type effects, but which type is it?
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Amiodarone
Type III |
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Type II antiarrythmic drug
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pour son acceuil espere mon nom avant
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... prolong phase 3 & the action potential, prolong QT, Torsades de Pointes
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type III antiarrythmic
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Torsades de Pointes is seen w
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Type I
Type III |
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Effect of Amiodarone r
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all 4 classes
anti-thyroid reduces cell-cell coupling (MOA) |
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Given IV or oral for recurrent/resistant or unstable VF, VT refractory to other therapy, maintain sinus rhythm in atrial fibrillation
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Amiodarone
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T or F
Amiodarone is ... a) highly hydrophobic b) accumulates and elimintaes quickly c)may not require loading regimen d)theurapeutic level: 0.5-2 mg/ml e)metabolized by CYP3AC to des-ethyl-amiodarone, (inactive metabolite) |
a)true
b)F, slowly 4 both c)F, may require loading regimen d)F, ug/ml e)F, metabolized by "CYP3A4" to des-ethyl-amiodarone, ("active") metabolite) |
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...inhibit hepatic metabolism & renal elimination of many drugs
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Amiodarone
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Amiodarone increase the effect of
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quick war, pro d*efence (7)
verapamil, diltiazem |
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what decreases Amiodarone's level?
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Cholestiramine & phenytoin
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Must watch for Amiodarone r
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liver, lungs, eyes, muscle, thyroid
pulmonary fibrosis less than 200 mg/d LFT, CK, thyroid Corneal microdeposits |
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Type IV Anti-arrhythmics.
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Calcium channel Blockers
Verapamil, diltiazem, bepridil. Bepridil has additional type III effects. |
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Type III Anti-arrhythmics.
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Potassium channel blockers
prolong phase 3 and the action potential). Bretylium, amiodarone, sotalol. Amiodarone has also type I, II and IV actions. |
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Drugs that prolong the QT interval
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Antimicrobials:
macrolides (erythromycin, chlarithromycin) Pentamidine Fluoroquinolones (grepafloxacin, moxifloxacin, levofloxacin) Tricyclic antidepressants: imipramine desipramine amitrypiline doxepin Thioridazine, mesoridazine, haloperidol, resperidone, ziprasidone, quetiapine Cisapride Indapamide |
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Drugs that inhibit potassium currents
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Bretylium
Amiodarone Sotalol Quinidine Procainamide Dispyramide antibiotics and antidepressants |
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New drug and treatment for CHF
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Etomoxir
inhibits carnitine palmitoyl-tranferase 1 (CPT1) a key enzyme of mitochondrial fatty acid oxidation shifts from fatty acid oxidation to glucose oxidation |
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Most common employed drugs to attempt RYTHYM control?
Hypokalemia is seen... |
amiodaron
Sotalol Dofetilide quinidine drug induced QT prolongation |
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most antiarrhythmis drugs have what effect?
examples |
negative inotropic effects which worse HF
quinidine procainamide propafenone d-sotalol exception: Amidoranone- class III drug but it has a sympatholytic action |
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Drug w proven effect on QT interval (IKr): Class III
antiarrhythmics |
amiodarone
bretylium ibutilide dofetilide |
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Drug w proven effect on QT interval (IKr) : Class I and II (III)
anti-arrhythmics: |
quinidine
procainamide disopyramide Sotalol propafenone bepridil |
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Drug w proven effect on QT interval: Anti-Psychotics
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Chlorpromazine
Thioridazine Mesoridazine Risperidone Ziprasidone Haloperidol-Droperidol Quetiapine Pimozide |
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Drug w proven effect on QT interval: Anti-Depressants
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Desipramine-imipramine
Doxepin Fluoxetine Paroxetine Sertraline Venlafaxine |
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Drug w proven effect on QT interval : Antibiotics
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Pentamidine
Erythromycin Clarithromycin Levofloxacin Gatifloxacin Moxifloxacin Sparfloxacin |
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Drug w proven effect on QT interval: Others
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Cisapride
Felbamate, Fosphenytoin, Foscarnet Tacrolimus Probucol Sumatriptan, Naratriptan, Zolmitriptan Tizanidine Indapamide, moexipril |
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Drug w proven effect on QT interval (Sum)
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Class III
antiarrhythmics Class I and II (III) anti-arrhythmics Anti-Psychotics Anti-Depressants Antibiotics |
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a)Most common arrythmias
b) Amiodarone is combined w... c)Which arrythmia is most commom in pt w HF d) which drugs r AV blockers? |
a)Atrial fibrillation
b)warfarin c)atrial fibrillation d)(CCB) digoxin, diltiazem, verapamil |
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symptoms of ADHF
Goal of therapy in ADHF |
Dyspnea, Edema, arrythmia
increase stroke vol W diuretics, natriuretic peptides, + inotropes, ON |
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Loop Diuretics for ADHF
caution |
Furosemide. torsemide, bumetanide
balance to avoid SNS/RAAS activation |
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+ inotropes for ADHF:Ca sensitizers
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Digitalis
Ca sensitizers: Levosimendan(hedache, hypot.) Istaroxime (not in the US) |
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reserve for HF pt w afib
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digoxin, also vagal stimulation
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+ inotropes for ADHF: B agonist
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B agonist: dopamine 2-5 ng/kg/min renal dose, 5-10 heart dose, 10-20 pressor dose
Dobutamine Epi: cardiogenic shock, cardiac arrest @ low dose (dopa) |
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+ inotropes for ADHF: PDEI 3
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PDEI 3 selective: Milrinome shorter t1/2 = preferred, Inamrinone, both give arrythmia, not 4 Chronic HF
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Which are given IV for ADHF? 5 BP DION
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B agonist
Digoxin ON PDEI 3 Nesiritide (Natrecor) |
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+ inotropes for ADHF: natriuretic
composition SE |
Nesiritide (Natrecor)
recombinant human BNP important biomarker of chronic HF severity SE: hypotension |
