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131 Cards in this Set
- Front
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digoxin
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AV nodal blocking agent; increases refractory period
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adenosine
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slows AV conduction
interrupts reentry pathways |
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quinidine
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converts AF and PVC to NSR
used in life-threatening arrhythmias |
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contraindication of quinidine
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history of long QT syndrome or drug induced torsades
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with quinidine, pretreat with ___ before use in AF or flutter to control ventricular rate
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digoxin
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quinidine: ADR
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cinchonism (tinnitus, HA, dizziness)
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procainamide principal metabolite
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NAPA formed by conjugation in the liver
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most frequent cause of drug-induced lupus
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procainamide
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lidocaine: ineffective for ___ and ___
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AF and Aflutter
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used for acute management of vent arrhythmias occurring during cardiac manipulation
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lidocaine
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converts nonsustained VT to NSR
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lidocaine
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box warning for flecainide
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due to pro-arrhythmic effects, its use is unacceptable in pts whose arrhythmias are not life threatening
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propafenone indicated in what
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documented life-threatening vent arrhythmias
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beta blockers: mech of action
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controls vent rate response in AF by slowing AV conduction
increases refrac period of AV |
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what BB is ultra short-acting for arrhythmias
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esmolol
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2 BBs for arrhythmias
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propranolol
esmolol |
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amiodarone: pharmacologic actions
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prolongs the action potential duration and effective refractory period of all cardiac excitable tissue
decreases conduction velocity in cardiac tissues noncompetitive antag at periph A and B receptors (decreases HR, TPR, FOC) |
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amiodarone: ADRs
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if pulm fibrosis, d/c amiodarone
elevates hepatic enz hypothyroidism corneal microdeposits sympto bradycardia, heart block worsening of CHF hypotension photodermatitis |
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amiodarone: DI
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digoxin
warfarin |
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sotalol
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nonselective BB
prolongs QT interval which can lead to torsades |
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ibutilide: indications
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IV infusion for rapid conversion of AF or flutter of recent onset to NSR
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dofetilide: indications
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acute conversion of AF or flutter to NSR and for maintenance of NSR after conversion
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verapamil: actions
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CCB
slows AV conduction by increasing refract period of AV node; prolongs AV conduction time w/no effects on P waves or QRS duration |
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verapamil: indications
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temporary control of rapid ventr rate in AF or AFlutter except when these arrhythmias are associated with accessory bypass tracts (WPW syndrome)
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verapamil: contraindications
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WPW syndrome accompanied by AF or flutter
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diltiazem
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pharm actions similar to verapamil
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DOC for prompt conversion of parox supra tachy to NSR
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adenosine
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EKG findings in wolf park white syndrome
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short PR
wide QRS parox tachy (either AV reentrant tachy or AF) |
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wolf park white with AF: contraindications
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AV nodal blocking agents (verapamil, diltiazem, digoxin, adenosine)
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complications of untreated AF
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increased risk of cerebral thromboembolism
increased mortality decreased diast filling time irregular and rapid vent rate |
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AF: signs/sxs
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palpitations
chest pain dyspnea fatigue lightheadedness syncope hemodynamic complications (rapid HR, impaired coronary perf, decreased CO) |
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AF: DOCs for pharm cardioversion
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class III, class IC
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AF: for electrical cardioversion, the shock is synchronized with the __ wave...why?
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R wave
to avoid stimulation during the repol phase |
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rate control in AF: what are most commonly used drugs
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nondihydropyridine CCBs (verapamil, diltiazem)
BBs (metoprolol) digoxin |
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rate control is used for what types of AF
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acute, new onset AF
chronic AF |
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rhythm control in AF: most commonly used drugs
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class III: amiodarone***, dronedarone, sotalol, dofetilide
class IC: flecainide, propafenone |
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dronedarone contra in what
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NYHA class IV HF or symptomatic HF with recent decompensation
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postcardioversion prophylaxis: what is required for AF >48 hrs
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anticoagulation to prevent formation of new clots and extension of already existing clots
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CHADS2 score
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evaluates risk of stroke
0 - treated with aspirin 1 - intermediate risk; warfarin or aspirin >2 - high risk; warfarin |
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unfractionated heparin is only used ____
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parenterally
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heparin: basic mech of action
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prevents extension of already formed clots
prevents new clot formation |
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heparin-ATII complex inactivates what 4 factors
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IIa, IXa, Xa, XIIa
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what factor converts prothrombin to thrombin
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Xa
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what factor converts fibrinogen to fibrin
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IIa (thrombin)
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heparin has a low bioavailability due to what? results in....
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binding to plasma proteins, endo cells, and macrophages
results in high variability and inability to predict dose-response |
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heparin administered what 2 ways
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IV
SC |
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aPTT tells you what
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alterations in the intrinsic pathway
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heparinization that prolongs the aPTT to _____ times normal has been considered adequate to prevent clot extension/formation
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1.5-2.5 times
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heparin: indications
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DVT and PE
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heparin: ADRs
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serious hemorrhage from OD
thrombocytopenia osteoporosis |
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antidote for heparin OD
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protamine sulfate
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what drugs is indicated for tx of hep-induced thrombo
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lepirudin
argatroban also warfarin for long-term |
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lepirudin: irreversible inhibitor of ____
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thrombin
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hirudin: derived from
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saliva of leeches
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argatroban
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synthetic direct thrombin inhibitor derived from arginine
prevention/tx of thrombosis in HIT |
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both UFH and LMWH can inactivate factor __
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Xa
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which form of heparin has exerts less inactivation of IIa (thrombin)
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LMWH
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___ inactivate Xa about 4 times as effectively as ___
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LMWH
IIa |
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advantages of LMWHs
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aPTT doesn't need to be monitored
greater bioavail longer half life has a predictable dose response |
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pts with hx of HIT should not receive ____
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LMWH
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first line therapy for prevention/tx of venous thromboembolism
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LMWHs
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enoxaparin sodium: class and indications
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LMWH
prophylaxis of DVT which may lead to PE; during and post-op hip replacement; knee replacement; at risk for thromboembolic complication |
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enoxaparin sodium: ADRs
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serious hemorrhage (less incidence than UFH)
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antidote for for LMWH-induced bleeding
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protamine sulfate
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how to administer LMWH
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SC only
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warfarin inhibits what enzyme
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vitK epoxide reductase
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warfarin inactivates what factors
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II, VII, IX, X
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what do you need to monitor when giving warfarin
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PT
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warfarin has no direct effect on ____ but prevents ____
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formed thrombus
prevents further extension and new clot formation |
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warfarin: indications
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prophylaxis/tx of DVT, PE, and AF with embolization
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warfarin: dosing
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5-10 mg once a day
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warfarin: ADRs
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minor bleeding
hemorrhage from OD |
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antidote for warfarin OD
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phytonadione (vit K1)
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warfarin: DIs
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enhances warfarin action
synergistic with aspirin (and other NSAIDs) can also inhibit warfarin action |
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bivalirudin
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related to hirudin; approved in US
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factor Xa inhibitors (2)
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fondaparinux
rivaroxaban |
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warfarin, dabigatran, rivaroxaban: which is more effective for AF
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dabigatran
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warfarin, dabigatran, rivaroxaban: which one causes more bleeding
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all 3 similar
intracranial bleeds more with warfarin GI bleeds more with other 2 |
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warfarin, dabigatran, rivaroxaban: which causes dyspepsia
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dabigatran
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warfarin, dabigatran, rivaroxaban: least expensive
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warfarin
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aminocaproic acid
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inhibits fibrinolysis
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tranexamic acid
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compet inhibits plasminogen activation and noncomp inhibits plasmin
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_____ is 10x more potent than aminocaproic acid
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tranexamic acid
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indications for tranexamic acid
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hemophilia
during and following tooth extraction |
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contraindications for fibrinolytics
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hemorrhagic stroke
acute pericarditis active internal bleeding known intracranial neoplasm |
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alteplase
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tissue plasminogen activator (tPA)
indicated in STEMI |
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reteplase
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tPA; longer half life than alteplase
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tenecteplase
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tPA
prolonged half life allows single bolus dosing highest specificity for pathologic fibrin clots lowest antigenic potential |
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what are the 3 tPAs we need to know
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alteplase
reteplase tenecteplase |
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aspirin inhibits what formation
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TXA2
irreversibly acetylates COX-1 for the lifetime of the platelet (10 days) |
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ticlopidine, clopidogrel are what class
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ADP receptor antagonists (inhibit agg)
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eptifibatide, tirofiban are what class
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GPIIb/IIIa antagonists (anti-platelets)
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indications for aspirin
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primary prevention of MI
secondary prevention of MI secondary prevention of stroke acute coronary syndromes |
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aspirin: for men benefit is to prevent _____, for women it is ____
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a first heart attack
a first stroke |
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dipyridamole
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inhibits platelet PDE
increases platelet cAMP inhibits platelet adhesion and aggreg |
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black box warning for ticlopidine
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neutropenia
TTP |
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clopidogrel or ticlopidine: which is more potent; which has much lower incidence of bleeding disorders; which has lower incidence of neutropenia
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clopidogrel for all 3
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prasugrel: indication
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reduce rate of thrombotic CV events, including stent thrombosis, in patients with ACS who are to be managed by PCI
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ticagrelor, compared to clopidogrel and prasugrel:
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has a faster onset since is not a prodrug
binds to platelets reversibly so effects are shorter lasting |
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ticagrelor: ADR
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dyspnea
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eptifibatide
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anti-platelet used in pts with ACS and pts undergoing PCI
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tirofiban
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anti-platelet; used with heparin for tx of ACS
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abciximab
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inhibits platelet aggreg by binding to GPIIb/IIIa platelet receptor sites
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acute coronary syndrome: definition
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operational term that refers to any group of sxs that indicate myocardial ischemia
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when are nitrates contraindicated
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SBP <90 mmHg
severe brady tachycardia in absence of sympto HF RV infarction on a PDE inhibitor |
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what should be d/c when pts present with UA/NSTEMI
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all NSAIDs (except aspirin)
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class III: IV BBs should not be given to STEMI pts with what
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signs of HF or low output state indicating severe LV dysfunction
ADHF increased risk of cardiogenic shock 2nd/3rd degree heart block |
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class III NSAIDs (excluding ASA) should not be administered during hospitalization for _____
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STEMI
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CCBs are not shown to reduce mortality in pts with ____
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STEMI
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cholestyramine: class and action
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bile acid sequestrant
major use is for isolated increases in LDL releasees Cl- in exchange for anions of bile acids in the SI |
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colesevelam
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bile acid sequestrant
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nicotinic acid: aka? mech of action?
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niacin
strongly inhibits lipolysis in adipose tissue; decreased fatty acid release; decreased hep synth of TG; decreased hep VLDL production (LDL too) |
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LDL is a ____ degradation product
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VLDL
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3 pharm effects of niacin
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reduces LDL
reduces TG increases HDL |
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most effective anti-hyperlipidemic for increasing HDL
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niacin
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niacin: ADRs
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mild to severe cutaneous flushing
sensation of warmth redness, itching, burning |
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fibric acids
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stimulate lipoprotein lipase activity
reduces VLDL decreases serum TG |
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fibric acids are the DOC for what
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reduction of TG in hyperTGemia with normal cholesterol levels
familial dysbetalipoproteinemia |
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fibric acids: ADRs
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dyspepsia
gallstones myopathy and rhabdomyolysis (if taken with a statin) |
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fibric acids: contra in what 3 diseases
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hepatic, gall bladder, and renal
|
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gemfibrozil
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fibric acid
for hyperTGemia in pts at risk for pancreatitis |
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gemfibrozil: contraind
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hepatic or severe renal dysfunction
gall bladder dz |
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fenofibrate
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adjunct to diet in pts with very high TG
prodrug which is completely hydrolyzed in the duodenum (active metabolite is fenofibric acid) |
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fenofibrate: contraind
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hepatic dz and gallbladder dz
|
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HMG-CoA reductase inhibitors: aka
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statins
|
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mech of action of statins
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compet inhibition of HMG-CoA reductase
reduces hepatocellular cholest upregulation of LDL (increased clearance) |
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most effective class at decreasing the number of small dense LDL particles
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statins
|
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stains plus ____ (3) increases risk of myopathy
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grapefruit juice, fibric acids, niacin
|
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which statins have DIs with P450 inhibitors
|
lovastatin
simvastatin atorvastatin |
|
most potent statin in lowering LDL
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rosuvastatin
|
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ezetimibe
|
cholesterol absorption inhibitor
acts at brush border of SI epi cells to block cholesterol absorption |
